Provider Demographics
NPI:1043644016
Name:ISMAIL, OSAMA (DDSMS)
Entity type:Individual
Prefix:DR
First Name:OSAMA
Middle Name:
Last Name:ISMAIL
Suffix:
Gender:M
Credentials:DDSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2184B BLOOMINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-1614
Mailing Address - Country:US
Mailing Address - Phone:630-529-5559
Mailing Address - Fax:630-529-5742
Practice Address - Street 1:2184B BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1614
Practice Address - Country:US
Practice Address - Phone:630-529-5559
Practice Address - Fax:630-529-5742
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL019-021834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist