Provider Demographics
NPI:1073040143
Name:KABBANI, NADIA (DMD)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:KABBANI
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 1:385 S COLUMBIA ST AEGD PROGRAM CB 7450 UNC SCHOOL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-3576
Mailing Address - Country:US
Mailing Address - Phone:919-537-3576
Mailing Address - Fax:919-537-3586
Practice Address - Street 1:6316 E INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-6953
Practice Address - Country:US
Practice Address - Phone:980-265-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC91751223G0001X
NC116631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice