Provider Demographics
NPI:1063582690
Name:BARSOUM, MAHER LABIB (DENTIST)
Entity type:Individual
Prefix:DR
First Name:MAHER
Middle Name:LABIB
Last Name:BARSOUM
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6017
Mailing Address - Country:US
Mailing Address - Phone:909-920-5222
Mailing Address - Fax:909-920-5220
Practice Address - Street 1:258 E 9TH ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6017
Practice Address - Country:US
Practice Address - Phone:909-920-5222
Practice Address - Fax:909-920-5220
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44145OtherDENTIST LICENSE