Provider Demographics
NPI:1053916064
Name:ABOULKHAIR, OSAMA (DMD)
Entity type:Individual
Prefix:DR
First Name:OSAMA
Middle Name:
Last Name:ABOULKHAIR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:OZ
Other - Middle Name:
Other - Last Name:ABOULKHAIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:111 SWEET THORNE RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8312
Mailing Address - Country:US
Mailing Address - Phone:703-438-0060
Mailing Address - Fax:
Practice Address - Street 1:2123 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7007
Practice Address - Country:US
Practice Address - Phone:703-438-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC97551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice