Provider Demographics
NPI:1407987399
Name:ARNETT JABBOUR, MARY ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:ARNETT JABBOUR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ31485Medicaid