Provider Demographics
NPI:1528639887
Name:MUSHARBASH, EHAB (DMD)
Entity type:Individual
Prefix:
First Name:EHAB
Middle Name:
Last Name:MUSHARBASH
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 1:1761 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4111
Mailing Address - Country:US
Mailing Address - Phone:954-990-5657
Mailing Address - Fax:954-990-5689
Practice Address - Street 1:1761 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4111
Practice Address - Country:US
Practice Address - Phone:954-990-5657
Practice Address - Fax:954-990-5689
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid