Provider Demographics
NPI:1073358917
Name:AWAD SHALASH OLIVE TREE DENTAL LLC
Entity type:Organization
Organization Name:AWAD SHALASH OLIVE TREE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSAB
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALASH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-684-3947
Mailing Address - Street 1:7764 COLERAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-4504
Mailing Address - Country:US
Mailing Address - Phone:513-741-2253
Mailing Address - Fax:
Practice Address - Street 1:7764 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-4504
Practice Address - Country:US
Practice Address - Phone:513-741-2253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental