Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 019033219 | IL |
NPI | 1083285704 |
---|---|
Provider Name | Dr. Rula Sabah Odeh Amarin |
First Address | Edwardsville, IL 62025-2580 |
Second Address | Edwardsville, IL 62025-2580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2021 |
Last Update Date | 18/11/2021 |