Provider Demographics
NPI:1851079750
Name:ABDULLAH, EZZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:EZZA
Middle Name:
Last Name:ABDULLAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:EZZA
Other - Middle Name:
Other - Last Name:ABDULLAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1919 7TH AVENUE SOUTH
Mailing Address - Street 2:SDB 315
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0007
Mailing Address - Country:US
Mailing Address - Phone:205-934-4546
Mailing Address - Fax:
Practice Address - Street 1:1919 7TH AVENUE SOUTH
Practice Address - Street 2:SDB 315
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0007
Practice Address - Country:US
Practice Address - Phone:205-934-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL39020000X1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry