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General NPI Number Information
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NPI Number | 1962291336
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Entity Type | Individual
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Provider Name | ALA EDDIN OMAR OBEIDALLAH
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Gender | Male
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 3130 S WESTNEDGE AVE
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City | KALAMAZOO
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State | MI
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Zip | 49008-4927
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Country | US
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Telephone | 269-459-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 50634 SILVERTON
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City | CANTON
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State | MI
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Zip | 48187-7703
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Country | US
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Telephone | 862-374-9067
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901602587
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License Number State | MI
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