MEDICARE: MINA ABDULLAH DDS

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	30212	TX
2	1223G0001X	General Practice Dentistry	65266	CA

General Provider Information

NPI Number	:	1710393327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINA ABDULLAH DDS

Provider Business Mailing Address
First Line	:	11051 CAMINO PLAYA CARMEL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-4140
Country	:	US
Telephone Number	:	619-767-8039
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	:	619-767-8039
Fax Number	:

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

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	03/14/2019

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