Provider Demographics
NPI:1336394873
Name:KHASAWNEH, ISLAM ABDELHADY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ISLAM
Middle Name:ABDELHADY
Last Name:KHASAWNEH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13730 FM 620
Mailing Address - Street 2:APT 427
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-1034
Mailing Address - Country:US
Mailing Address - Phone:443-889-3147
Mailing Address - Fax:
Practice Address - Street 1:12335 HYMEADOW DR
Practice Address - Street 2:STE 250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1934
Practice Address - Country:US
Practice Address - Phone:512-250-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242871223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice