Provider Demographics
NPI:1710001912
Name:ANTOON, OUSAMA (DMD)
Entity Type:Individual
Prefix:DR
First Name:OUSAMA
Middle Name:
Last Name:ANTOON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 PRESTON ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2610
Mailing Address - Country:US
Mailing Address - Phone:972-267-5000
Mailing Address - Fax:972-267-5002
Practice Address - Street 1:6521 PRESTON ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2610
Practice Address - Country:US
Practice Address - Phone:972-267-5000
Practice Address - Fax:972-267-5002
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice