Provider Demographics
NPI:1154557072
Name:ALGHADBAN, HOUSSAM EDDIN (DDS)
Entity type:Individual
Prefix:DR
First Name:HOUSSAM
Middle Name:EDDIN
Last Name:ALGHADBAN
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 1:18850 STONE OAK PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4113
Mailing Address - Country:US
Mailing Address - Phone:321-947-0919
Mailing Address - Fax:
Practice Address - Street 1:18850 STONE OAK PKWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4113
Practice Address - Country:US
Practice Address - Phone:210-402-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAS-4611223P0300X
TX247971223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics