Provider Demographics
NPI:1407555121
Name:JASON S. DAABOUL DDS PA
Entity Type:Organization
Organization Name:JASON S. DAABOUL DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:SAAD-EDDINE
Authorized Official - Last Name:DAABOUL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-690-8088
Mailing Address - Street 1:2800 WILLIAM D. TATE AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:817-488-7885
Mailing Address - Fax:817-421-6176
Practice Address - Street 1:2800 WILLIAM D. TATE AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:817-488-7885
Practice Address - Fax:817-421-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental