Provider Demographics
NPI:1194860221
Name:TABIBI, ABBAS (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:ABBAS
Middle Name:
Last Name:TABIBI
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 WEST LN
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1923
Mailing Address - Country:US
Mailing Address - Phone:763-421-6380
Mailing Address - Fax:763-421-6640
Practice Address - Street 1:11464 ROBINSON DRIVE NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433
Practice Address - Country:US
Practice Address - Phone:763-767-6202
Practice Address - Fax:763-767-6259
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND80621223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics