Provider Demographics
NPI:1386274579
Name:WIAM JABBAR, D.D.S.,INC.
Entity type:Organization
Organization Name:WIAM JABBAR, D.D.S.,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JABBAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-451-0908
Mailing Address - Street 1:12125 ALTA CARMEL CT STE 330
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3841
Mailing Address - Country:US
Mailing Address - Phone:858-451-0908
Mailing Address - Fax:858-451-1880
Practice Address - Street 1:12125 ALTA CARMEL CT STE 330
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3841
Practice Address - Country:US
Practice Address - Phone:858-451-0908
Practice Address - Fax:858-451-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental