Provider Demographics
NPI:1720168693
Name:SAWALHA, LAITH A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAITH
Middle Name:A
Last Name:SAWALHA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6278
Mailing Address - Country:US
Mailing Address - Phone:740-387-5188
Mailing Address - Fax:740-382-3464
Practice Address - Street 1:716 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6278
Practice Address - Country:US
Practice Address - Phone:740-387-5188
Practice Address - Fax:740-382-3464
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0220851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2669894Medicaid