Provider Demographics
NPI:1437226099
Name:NOUGED, EHAB M
Entity type:Individual
Prefix:DR
First Name:EHAB
Middle Name:M
Last Name:NOUGED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 CROWN BENCH CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-4607
Mailing Address - Country:US
Mailing Address - Phone:916-761-6469
Mailing Address - Fax:209-473-1574
Practice Address - Street 1:1407 W MARCH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6111
Practice Address - Country:US
Practice Address - Phone:209-473-1129
Practice Address - Fax:209-473-1574
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist