Provider Demographics
NPI:1790429082
Name:AL ABDULLAH, USAMA SAAD FARHAN (DMD)
Entity type:Individual
Prefix:
First Name:USAMA
Middle Name:SAAD FARHAN
Last Name:AL ABDULLAH
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12450 CLEVELAND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-8355
Mailing Address - Country:US
Mailing Address - Phone:919-772-9927
Mailing Address - Fax:919-772-0647
Practice Address - Street 1:12450 CLEVELAND RD STE 100
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-8355
Practice Address - Country:US
Practice Address - Phone:919-772-9927
Practice Address - Fax:919-772-0647
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-23
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC140961223G0001X
NV7681122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist