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79 Thurman Ave Columbus OH 43206-2685 | |
| (614) 443-4625 | |
| (614) 443-6558 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 79 Thurman Ave, Columbus, Ohio |
| Authorized Official Name and Position | Tam Ngoc Issa-abbas (PRESIDENT/OWNER) |
| Authorized Official Contact | 6145375061 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
79 Thurman Ave Columbus OH 43206-2685 Ph: (614) 443-4625 | 79 Thurman Ave Columbus OH 43206-2685 Ph: (614) 443-4625 |
| NPI Number | 1821415746 |
|---|---|
| Provider Enumeration Date | 03/28/2014 |
| Last Update Date | 03/28/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821415746 | NPI | - | NPPES |
| 0082242 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30023476 (Ohio) | Primary |
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