Healthcare Provider Details

I. General information

NPI: 1669802054
Provider Name (Legal Business Name): ISMAIL OKASHA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2013
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE ST
BALTIMORE MD
21201-1510
US

IV. Provider business mailing address

39 W LEXINGTON ST
BALTIMORE MD
21201-3910
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-7952
  • Fax:
Mailing address:
  • Phone: 414-331-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number15569
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: