Active NPI
Emad Abdallah
- Dentist
- San Antonio, TX
National Provider Identifier
1356864870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 38276
- Practice address
- 2311 Harry Wurzbach Rd
San Antonio, TX 78209-5543 - Phone
- (210) 824-3531
- Fax
- (210) 824-0068
- NPI assigned
- Jul 18, 2017
- Last updated
- Jul 30, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901022392 | MI | |
| Dentist | 122300000X | 38276 | TX | Primary |
Addresses
Primary practice location
2311 Harry Wurzbach Rd
San Antonio, TX 78209-5543
Mailing address
1347 Burning Arrow
San Antonio, TX 78258-2765
Phone (617) 319-1050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171213000746 | MI | Order and Referring Only - Dentist | 1658639091 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901022392 | MI | MD | Dentist |
| 38276 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elevate Dental | Dentist | Current | Accepting new patients |
| Shoreline Dental Center | Dentist | Past | Accepting new patients |
| Professional Dental Alliance of Michigan, LLC | Dentist | Past | Accepting new patients |
Locations
2311 Harry Wurzbach Rd
San Antonio, TX 78209
Phone (210) 824-3531
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Dental Care of Michigan, Shores
- Dentist
- Saint Clair Shores, MI
- NPI 1245589563
-
- Dentist
- Saint Clair Shores, MI
- NPI 1063609220
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690675200000",
"number": "1356864870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1347 BURNING ARROW",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782582765",
"telephone_number": "617-319-1050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2311 HARRY WURZBACH RD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782095543",
"telephone_number": "210-824-3531",
"fax_number": "210-824-0068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ABDALLAH",
"first_name": "EMAD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-07-18",
"last_updated": "2023-07-30",
"certification_date": "2023-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901022392",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "38276",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.