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General NPI Number Information
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NPI Number | 1528346236
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Entity Type | Individual
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Provider Name | OSSAMA ONSI BOULOS D.M.D
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Gender | Male
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 11/21/2021
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Provider Practice Location Address
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Address Line | 511 ST. CLAIR AVE.
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City | CLAIRTON
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State | PA
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Zip | 15102-0089
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Country | US
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Telephone | 412-233-3313
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Fax | 412-233-4675
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Provider Business Mailing Address
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Address Line | 511 ST. CLAIR AVE. P.O BOX 89
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City | CLAIRTON
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State | PA
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Zip | 15102-0089
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Country | US
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Telephone | 412-233-3313
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Fax | 412-233-4675
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS-028568-L
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License Number State | PA
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