Provider Demographics
NPI:1417831801
Name:ABDALLA, ILHAM (DDS)
Entity type:Individual
Prefix:
First Name:ILHAM
Middle Name:
Last Name:ABDALLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 36TH AVE S APT 302
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-7280
Mailing Address - Country:US
Mailing Address - Phone:612-759-8494
Mailing Address - Fax:
Practice Address - Street 1:1650 45TH ST S STE 108
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3247
Practice Address - Country:US
Practice Address - Phone:701-526-4652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND25701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice