Provider Demographics
NPI:1821415746
Name:TAM N ISSA-ABBAS LLC
Entity Type:Organization
Organization Name:TAM N ISSA-ABBAS LLC
Other - Org Name:CAPITAL CITY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAM
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:ISSA-ABBAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-537-5061
Mailing Address - Street 1:79 THURMAN AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2685
Mailing Address - Country:US
Mailing Address - Phone:614-443-4625
Mailing Address - Fax:614-443-6558
Practice Address - Street 1:79 THURMAN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-2685
Practice Address - Country:US
Practice Address - Phone:614-443-4625
Practice Address - Fax:614-443-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300234761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082242Medicaid