Provider Demographics
NPI:1134897010
Name:AL-AZZAWI, OSAMAH M
Entity type:Individual
Prefix:DR
First Name:OSAMAH
Middle Name:M
Last Name:AL-AZZAWI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 N SAM HOUSTON PKWY E STE 430
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-3418
Mailing Address - Country:US
Mailing Address - Phone:832-369-6775
Mailing Address - Fax:
Practice Address - Street 1:329 E GIBSON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-5028
Practice Address - Country:US
Practice Address - Phone:409-489-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37783122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX37783OtherDENTAL LICENSE