Provider Demographics
NPI:1932453198
Name:ABULHASAN, MARWA B (DMD, MS, MMM)
Entity Type:Individual
Prefix:DR
First Name:MARWA
Middle Name:B
Last Name:ABULHASAN
Suffix:
Gender:F
Credentials:DMD, MS, MMM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 SILVER SPUR RD # 607
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3800
Mailing Address - Country:US
Mailing Address - Phone:412-608-2381
Mailing Address - Fax:
Practice Address - Street 1:925 W 34TH ST # 108
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-3075
Practice Address - Country:US
Practice Address - Phone:412-608-2381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4893-PE1223P0300X
NVS4-111C1223P0300X
CA562361223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics