Provider Demographics
NPI:1568608610
Name:ABDEL-WAHAB, KAMAL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:A
Last Name:ABDEL-WAHAB
Suffix:
Gender:M
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:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-0655
Mailing Address - Country:US
Mailing Address - Phone:937-342-5370
Mailing Address - Fax:937-342-5372
Practice Address - Street 1:1980 KINGSGATE RD STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-8226
Practice Address - Country:US
Practice Address - Phone:937-342-5370
Practice Address - Fax:937-342-5372
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH186581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0679565Medicaid