Provider Demographics
NPI:1144242843
Name:ABC DENTISTRY PASADENA, PA
Entity Type:Organization
Organization Name:ABC DENTISTRY PASADENA, PA
Other - Org Name:ABC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRAJ
Authorized Official - Middle Name:S
Authorized Official - Last Name:JABBARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-944-6800
Mailing Address - Street 1:1500 SOUTHMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-1307
Mailing Address - Country:US
Mailing Address - Phone:713-944-6800
Mailing Address - Fax:
Practice Address - Street 1:1313 STRAWBERRY RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-2601
Practice Address - Country:US
Practice Address - Phone:713-472-6100
Practice Address - Fax:713-472-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164551701Medicaid