Mouada Abdellatif Abdelaal Fadul, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DDS-10267 Issued in IA

Practice address

4090 Westown Pkwy Ste B1
West Des Moines, IA 50266-6760

Phone

(515) 267-0737

Fax

(515) 267-1480

NPI assigned

May 21, 2022

Last updated

Sep 13, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• University of Alabama at Birmingham

  • General Acute Care Hospital
  • Birmingham, AL
  • NPI 1447145818
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1427796382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "542 S 160TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681182120",
            "telephone_number": "252-481-1530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4090 WESTOWN PKWY STE B1",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502666760",
            "telephone_number": "515-267-0737",
            "fax_number": "515-267-1480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADUL",
        "first_name": "MOUADA",
        "middle_name": "ABDELLATIF ABDELAAL",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-21",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IA",
            "license": "DDS-10267",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "DDS-10267",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IA",
            "license": "DDS-10267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eyemart Express LLC
• Eyemart Express LLC
• Eyemart Express, LTD. (Vision 4 Less)
• Stephanie A Ezebuiro, MD
• Scott P Fackrell, DO
• Jonathan Andrew Fahler, DO
• Faith and Freedom Therapy LLC
• Family Directions of Iowa
• Family Orthodontics of Iowa, PLLC
• Fawad S. Zafar MD PC (Lakeview Center for Urology)

• Pediatric Dentistry in West Des Moines, IA
• Providers in West Des Moines, IA by specialty
• Pediatric Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.