Provider Demographics
NPI:1235501024
Name:ELIZABETH ARNETT JABBOUR DMD
Entity Type:Organization
Organization Name:ELIZABETH ARNETT JABBOUR DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ARNETT JABBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-582-2371
Mailing Address - Street 1:402 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-2712
Mailing Address - Country:US
Mailing Address - Phone:864-582-2371
Mailing Address - Fax:864-585-1949
Practice Address - Street 1:402 S PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2712
Practice Address - Country:US
Practice Address - Phone:864-582-2371
Practice Address - Fax:864-585-1949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3148261QD0000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1407987399Medicaid