Provider Demographics
NPI:1760618094
Name:ABDULLA, SHIMMA (DMD)
Entity Type:Individual
Prefix:
First Name:SHIMMA
Middle Name:
Last Name:ABDULLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2459 ARAMINGO AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3731
Mailing Address - Country:US
Mailing Address - Phone:610-704-6146
Mailing Address - Fax:
Practice Address - Street 1:2459 ARAMINGO AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-3731
Practice Address - Country:US
Practice Address - Phone:610-704-6146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0378641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice