Provider Demographics
NPI:1467714931
Name:ISSA-ABBAS, TAM NGOC (DDS)
Entity Type:Individual
Prefix:
First Name:TAM
Middle Name:NGOC
Last Name:ISSA-ABBAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 BANDERA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1400
Mailing Address - Country:US
Mailing Address - Phone:210-684-5040
Mailing Address - Fax:210-682-7785
Practice Address - Street 1:6502 BANDERA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1400
Practice Address - Country:US
Practice Address - Phone:210-684-5040
Practice Address - Fax:210-682-7785
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314891223G0001X
OH30.0234761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice