Provider Demographics
NPI:1871703926
Name:TRABOULSI, NADA J (DDS)
Entity type:Individual
Prefix:DR
First Name:NADA
Middle Name:J
Last Name:TRABOULSI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 E BIRCH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5155
Mailing Address - Country:US
Mailing Address - Phone:714-529-4477
Mailing Address - Fax:714-529-7031
Practice Address - Street 1:1220 E BIRCH ST STE 102
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5155
Practice Address - Country:US
Practice Address - Phone:714-529-4477
Practice Address - Fax:714-529-7031
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice