Provider Demographics
NPI:1528346236
Name:BOULOS, OSSAMA ONSI (DMD)
Entity type:Individual
Prefix:DR
First Name:OSSAMA
Middle Name:ONSI
Last Name:BOULOS
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 1:511 ST. CLAIR AVE.
Mailing Address - Street 2:P.O BOX 89
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15102-0089
Mailing Address - Country:US
Mailing Address - Phone:412-233-3313
Mailing Address - Fax:412-233-4675
Practice Address - Street 1:511 ST. CLAIR AVE.
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15102-0089
Practice Address - Country:US
Practice Address - Phone:412-233-3313
Practice Address - Fax:412-233-4675
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-028568-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice