Provider Demographics
NPI:1609050509
Name:GABRALLA, HUSHAM A (DDS)
Entity type:Individual
Prefix:DR
First Name:HUSHAM
Middle Name:A
Last Name:GABRALLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7939 HONEYGO BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5991
Mailing Address - Country:US
Mailing Address - Phone:443-510-6651
Mailing Address - Fax:410-670-4653
Practice Address - Street 1:7939 HONEYGO BLVD STE 103
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5991
Practice Address - Country:US
Practice Address - Phone:443-510-6651
Practice Address - Fax:410-670-4653
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD137621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty