Provider Demographics
NPI:1750860623
Name:ABBAS, IRTIZA GHULAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRTIZA
Middle Name:GHULAM
Last Name:ABBAS
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 1:1419 CEDAR RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7492
Mailing Address - Country:US
Mailing Address - Phone:757-410-5878
Mailing Address - Fax:757-257-0165
Practice Address - Street 1:1419 CEDAR RD STE 100
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7492
Practice Address - Country:US
Practice Address - Phone:757-410-5878
Practice Address - Fax:757-257-0165
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014161991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice