MEDICARE: ARWA ABUALSOUD D.M.D

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	0401413656	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0401413656	OTHER	VA	LICENSE NUMBER

General Provider Information

NPI Number	:	1558624569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARWA ABUALSOUD D.M.D

Provider Business Mailing Address
First Line	:	517 ALDERBROOK WAY
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40515-4795
Country	:	US
Telephone Number	:	859-806-4361
Fax Number	:

Provider Business Practice Location Address
First Line	:	3904 HULL STREET RD
Second Line	:	STE A
City	:	RICHMOND
State	:	VA
Zip	:	23224-1714
Country	:	US
Telephone Number	:	804-233-0007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	06/25/2012

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