Provider Demographics
NPI:1619407053
Name:DABUSH, SHMUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHMUEL
Middle Name:
Last Name:DABUSH
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 1:1617 DRYDEN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3907
Mailing Address - Country:US
Mailing Address - Phone:843-801-4264
Mailing Address - Fax:843-343-8173
Practice Address - Street 1:996 TANNER FORD BLVD
Practice Address - Street 2:
Practice Address - City:HANAHAN
Practice Address - State:SC
Practice Address - Zip Code:29410-4780
Practice Address - Country:US
Practice Address - Phone:843-212-8810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9970122300000X, 1223G0001X
SC10148122300000X
SC102841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice