Provider Demographics
NPI:1427244615
Name:ABUHAJLEH, OMAR (DMD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:ABUHAJLEH
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 1:10505 RISING RIDGE RD APT 604
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-8235
Mailing Address - Country:US
Mailing Address - Phone:781-254-2626
Mailing Address - Fax:
Practice Address - Street 1:10505 RISING RIDGE RD APT 604
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-8235
Practice Address - Country:US
Practice Address - Phone:781-254-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412655122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist