Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DL11457 | MA |
Y | 1223X0400X | Orthodontists | 12013725A | IN |
NPI | 1013284553 |
---|---|
Provider Name | Dr. Moufida Abufarwa |
First Address | Indianapolis, IN 46220-3479 |
Second Address | Indianapolis, IN 46220-3479 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2011 |
Last Update Date | 15/12/2021 |