Provider Demographics
NPI:1881372985
Name:ABDULLAH, OSAMA (DMD)
Entity type:Individual
Prefix:
First Name:OSAMA
Middle Name:
Last Name:ABDULLAH
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 1:2104 LOCH HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5231
Mailing Address - Country:US
Mailing Address - Phone:502-975-4911
Mailing Address - Fax:
Practice Address - Street 1:2305 LONGMIRE DR STE 700
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-7035
Practice Address - Country:US
Practice Address - Phone:918-801-8124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39698122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist