Provider Demographics
NPI:1366827347
Name:JABORI, ABEER
Entity Type:Individual
Prefix:
First Name:ABEER
Middle Name:
Last Name:JABORI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12812 COURAGE XING
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-5995
Mailing Address - Country:US
Mailing Address - Phone:419-262-6032
Mailing Address - Fax:
Practice Address - Street 1:12812 COURAGE XING
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-5995
Practice Address - Country:US
Practice Address - Phone:419-262-6032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012303A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12012303AOtherINDIANA PROFESSIONAL LICENSING AGENCY -DENTAL LICENSING BOARD