MEDICARE: MINA ABDULLAH DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1295293645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINA ABDULLAH DDS INC

Provider Business Mailing Address
First Line	:	767 JAMACHA RD
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-3202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	767 JAMACHA RD
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-3202
Country	:	US
Telephone Number	:	619-401-3214
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MINA ABDULLAH
Credential	:	DDS
Telephone Number	:	619-767-8039

Provider Enumeration Date	:	03/05/2019
Last Update Date	:	03/05/2019

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