Provider Demographics
NPI:1023894391
Name:USMAN, ABEHA (DMD)
Entity type:Individual
Prefix:
First Name:ABEHA
Middle Name:
Last Name:USMAN
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 1:3360 W FM 544 STE 930
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-9429
Mailing Address - Country:US
Mailing Address - Phone:972-915-0484
Mailing Address - Fax:
Practice Address - Street 1:3360 W FM 544 STE 930
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-9429
Practice Address - Country:US
Practice Address - Phone:972-915-0484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist