Provider Demographics
NPI:1366603987
Name:ABOU NASSAR, ELIE (DDS)
Entity type:Individual
Prefix:
First Name:ELIE
Middle Name:
Last Name:ABOU NASSAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 W TECUMSEH RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1840
Mailing Address - Country:US
Mailing Address - Phone:405-701-3111
Mailing Address - Fax:405-701-2524
Practice Address - Street 1:3600 W TECUMSEH RD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1840
Practice Address - Country:US
Practice Address - Phone:405-701-3111
Practice Address - Fax:405-701-2524
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60171223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice