Provider Demographics
NPI:1083285704
Name:AMARIN, RULA SABAH ODEH (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:RULA
Middle Name:SABAH ODEH
Last Name:AMARIN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 LINDENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-2580
Mailing Address - Country:US
Mailing Address - Phone:618-659-0456
Mailing Address - Fax:
Practice Address - Street 1:1811 LINDENWOOD AVE
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-2580
Practice Address - Country:US
Practice Address - Phone:618-659-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-03
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190332191223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics