Provider Demographics
NPI:1831180249
Name:OSMAN, FEISAL (DENTIST)
Entity type:Individual
Prefix:DR
First Name:FEISAL
Middle Name:
Last Name:OSMAN
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 LAUDERDALE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7800
Mailing Address - Country:US
Mailing Address - Phone:804-364-1696
Mailing Address - Fax:804-360-0756
Practice Address - Street 1:3033 LAUDERDALE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-7800
Practice Address - Country:US
Practice Address - Phone:804-364-1696
Practice Address - Fax:804-360-0756
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7801688Medicaid