Provider Demographics
NPI:1164603031
Name:TABBAH, LISA (DMD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:TABBAH
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 1:5A DR OSMAN BABSON RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1812
Mailing Address - Country:US
Mailing Address - Phone:978-281-3773
Mailing Address - Fax:978-281-0316
Practice Address - Street 1:5A DR OSMAN BABSON RD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1812
Practice Address - Country:US
Practice Address - Phone:978-281-3773
Practice Address - Fax:978-281-0316
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice