Provider Demographics
NPI:1982340444
Name:HABEEBALLA, AHMED
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:HABEEBALLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 YOUNGSTOWN WARREN RD STE 107
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4707
Mailing Address - Country:US
Mailing Address - Phone:330-652-3900
Mailing Address - Fax:
Practice Address - Street 1:5700 YOUNGSTOWN WARREN RD STE 107
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4707
Practice Address - Country:US
Practice Address - Phone:330-652-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH30.026946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program