Provider Demographics
NPI:1144062415
Name:ABULAILA, OMAR (DMD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:ABULAILA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13324 LAHINCH DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1135
Mailing Address - Country:US
Mailing Address - Phone:708-321-0940
Mailing Address - Fax:
Practice Address - Street 1:7250 S CICERO AVE STE F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5849
Practice Address - Country:US
Practice Address - Phone:708-496-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0351041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice