Individual
ABANUB FARAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2616 LAKEMOOR PL, WEST COVINA, CA 91792-1934
(626) 482-6021
Mailing address
2616 LAKEMOOR PL, WEST COVINA, CA 91792-1934
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
106577
CA
Other
Enumeration date
07/20/2021
Last updated
07/20/2021
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