Provider Demographics
NPI:1932986478
Name:ABU AL TAMN, STEVEN (BDS, MS)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:ABU AL TAMN
Suffix:
Gender:M
Credentials:BDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-7522
Mailing Address - Country:US
Mailing Address - Phone:281-250-5815
Mailing Address - Fax:
Practice Address - Street 1:2246 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-7522
Practice Address - Country:US
Practice Address - Phone:281-250-5815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019034658122300000X
IN12014244A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist