Provider Demographics
NPI:1336167774
Name:DABBAGH, IHAB (DMD)
Entity type:Individual
Prefix:
First Name:IHAB
Middle Name:
Last Name:DABBAGH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MILLBROOK ST
Mailing Address - Street 2:MILLBROOK DENTAL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606
Mailing Address - Country:US
Mailing Address - Phone:508-595-9432
Mailing Address - Fax:508-595-9749
Practice Address - Street 1:9 MILLBROOK ST
Practice Address - Street 2:MILLBROOK DENTAL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606
Practice Address - Country:US
Practice Address - Phone:508-595-9432
Practice Address - Fax:508-595-9749
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA191311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0281328Medicare ID - Type Unspecified