Provider Demographics
NPI:1447912894
Name:ABDELWAHAB, ESLAM M (DMD)
Entity type:Individual
Prefix:
First Name:ESLAM
Middle Name:M
Last Name:ABDELWAHAB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 TRAIL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3555
Mailing Address - Country:US
Mailing Address - Phone:908-727-2418
Mailing Address - Fax:
Practice Address - Street 1:100 E NEWTON STREET
Practice Address - Street 2:DEPT OF GENERAL DENTISTRY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-358-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38089122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist