Provider Demographics
NPI:1376564518
Name:JABBARY, IRAJ S (DDS)
Entity Type:Individual
Prefix:
First Name:IRAJ
Middle Name:S
Last Name:JABBARY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 E HOUSTON ST STE D
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4754
Mailing Address - Country:US
Mailing Address - Phone:281-593-3300
Mailing Address - Fax:281-593-1616
Practice Address - Street 1:1214 E HOUSTON ST STE D
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4754
Practice Address - Country:US
Practice Address - Phone:281-593-3300
Practice Address - Fax:281-593-1616
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135063902Medicaid