Individual
ODAI ABUSHANAB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
110 BERGEN ST, NEWARK, NJ 07103-2495
(973) 972-3126
Mailing address
82 SMITHTOWN RD, BUDD LAKE, NJ 07828-1932
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
22DI02760901
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2018
Last updated
06/04/2024
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