Provider Demographics
NPI:1851085013
Name:SHALASH, MUSAB (DMD)
Entity Type:Individual
Prefix:
First Name:MUSAB
Middle Name:
Last Name:SHALASH
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 1:3809 MARIPOSA CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-2017
Mailing Address - Country:US
Mailing Address - Phone:859-684-3947
Mailing Address - Fax:
Practice Address - Street 1:8944 COLUMBIA RD STE 2
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-1121
Practice Address - Country:US
Practice Address - Phone:513-774-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY109581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice