Provider Demographics
NPI:1609282425
Name:SHALABI, RULA MAHMOUD (DMD)
Entity type:Individual
Prefix:
First Name:RULA
Middle Name:MAHMOUD
Last Name:SHALABI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1673 E MAIN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3791
Mailing Address - Country:US
Mailing Address - Phone:864-442-6770
Mailing Address - Fax:864-442-6830
Practice Address - Street 1:1673 E MAIN ST UNIT B
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3791
Practice Address - Country:US
Practice Address - Phone:864-442-6770
Practice Address - Fax:864-442-6830
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX8355Medicaid