Healthcare Provider Details

I. General information

NPI: 1447170071
Provider Name (Legal Business Name): MOHAMAD OKAB
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3554 PROMENADE PKWY STE D
LAFAYETTE IN
47909-8418
US

IV. Provider business mailing address

820 GARDENBROOK CIR APT F
INDIANAPOLIS IN
46202-4659
US

V. Phone/Fax

Practice location:
  • Phone: 765-233-9590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12015099A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: