Provider Demographics
NPI:1962114785
Name:ALSHABEBI, BADR ESMAIL
Entity type:Individual
Prefix:
First Name:BADR
Middle Name:ESMAIL
Last Name:ALSHABEBI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 NORTHGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1641
Mailing Address - Country:US
Mailing Address - Phone:916-576-1403
Mailing Address - Fax:
Practice Address - Street 1:3645 NORTHGATE BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1641
Practice Address - Country:US
Practice Address - Phone:916-576-1403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108447122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist