Provider Demographics
NPI:1649623935
Name:ABU SABAA, ALAA H (DDS)
Entity type:Individual
Prefix:
First Name:ALAA
Middle Name:H
Last Name:ABU SABAA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E SOUTH WATER ST APT 3505
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-4146
Mailing Address - Country:US
Mailing Address - Phone:571-451-4809
Mailing Address - Fax:
Practice Address - Street 1:360 E SOUTH WATER ST APT 3505
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-4146
Practice Address - Country:US
Practice Address - Phone:571-451-4809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.031947122300000X
MADL12976122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist