Healthcare Provider Details

I. General information

NPI: 1609282425
Provider Name (Legal Business Name): RULA MAHMOUD SHALABI D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 POWDERSVILLE RD SUITE A
EASLEY SC
29642
US

IV. Provider business mailing address

1026 POWDERSVILLE ROAD SUITE A
EASLEY SC
29642
US

V. Phone/Fax

Practice location:
  • Phone: 864-442-6770
  • Fax: 864-442-6830
Mailing address:
  • Phone: 864-442-6770
  • Fax: 864-442-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8355
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierZA8955
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 2
IdentifierZX8355
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: