Provider Demographics
NPI:1104499698
Name:KABBANI, MANAR AL-DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MANAR
Middle Name:AL-DEAN
Last Name:KABBANI
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 1:13290 NOEL RD APT 522
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5673
Mailing Address - Country:US
Mailing Address - Phone:918-361-1108
Mailing Address - Fax:
Practice Address - Street 1:2411 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2906
Practice Address - Country:US
Practice Address - Phone:817-261-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK74361223G0001X
TX375431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice