Provider Demographics
NPI:1073403473
Name:TAWFIK, NADINE ASHRAF SIDKI
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:ASHRAF SIDKI
Last Name:TAWFIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 CORNERSTONE LN
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-6795
Mailing Address - Country:US
Mailing Address - Phone:310-218-8276
Mailing Address - Fax:
Practice Address - Street 1:3030 HARBOR BLVD STE G1
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2562
Practice Address - Country:US
Practice Address - Phone:714-546-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS111590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist