Provider Demographics
NPI:1013094598
Name:HIJAZI, OSAMA A (DDS)
Entity type:Individual
Prefix:
First Name:OSAMA
Middle Name:A
Last Name:HIJAZI
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 1:4880 WELLSPRING CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7842
Mailing Address - Country:US
Mailing Address - Phone:214-334-5797
Mailing Address - Fax:
Practice Address - Street 1:4930 W BROAD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1696
Practice Address - Country:US
Practice Address - Phone:614-853-4900
Practice Address - Fax:614-853-2415
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0220691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2538203Medicaid
OH1777823OtherUNITED CONCORDIA
OH9179698OtherDORAL