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General NPI Number Information
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NPI Number | 1447654355
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Entity Type | Organization
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Legal Business Name | HIJAZI DENTAL ASSOCIATES LLC
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Dates
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Enumeration Date | 10/21/2014
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Last Update Date | 11/18/2014
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Provider Practice Location Address
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Address Line | 4930 W BROAD ST SUITE 3
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City | COLUMBUS
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State | OH
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Zip | 43228-1696
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Country | US
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Telephone | 614-853-4900
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Fax | 614-853-2415
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Provider Business Mailing Address
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Address Line | 4880 WELLSPRING CT
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City | DUBLIN
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State | OH
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Zip | 43016-7842
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OSAMA HIJAZI
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Credential | DDS
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Telephone | 214-334-5797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 30-022069
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License Number State | OH
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