Provider Demographics
NPI:1962626861
Name:ALHALASA, ODAY (DDS,MSD)
Entity type:Individual
Prefix:DR
First Name:ODAY
Middle Name:
Last Name:ALHALASA
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:DR
Other - First Name:ODAY
Other - Middle Name:HUSAM
Other - Last Name:ALHALASA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS,MSD
Mailing Address - Street 1:71780 SAN JACINTO DR
Mailing Address - Street 2:B3
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5516
Mailing Address - Country:US
Mailing Address - Phone:760-779-0350
Mailing Address - Fax:760-779-0348
Practice Address - Street 1:71780 SAN JACINTO DR
Practice Address - Street 2:B3
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-5516
Practice Address - Country:US
Practice Address - Phone:760-779-0350
Practice Address - Fax:760-779-0348
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508821223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics