Provider Demographics
NPI:1003504598
Name:KABBARA, ALIA MEAGAN (DMD)
Entity Type:Individual
Prefix:
First Name:ALIA
Middle Name:MEAGAN
Last Name:KABBARA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18392 OLD LAMPLIGHTER CIR
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92861-4528
Mailing Address - Country:US
Mailing Address - Phone:714-944-3983
Mailing Address - Fax:
Practice Address - Street 1:3848 N MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-6569
Practice Address - Country:US
Practice Address - Phone:951-371-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist