Provider Demographics
NPI:1508189705
Name:SHAABAN,D.D.S.,INC.
Entity Type:Organization
Organization Name:SHAABAN,D.D.S.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHADY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAABAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-288-6511
Mailing Address - Street 1:12752 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1923
Mailing Address - Country:US
Mailing Address - Phone:714-636-2595
Mailing Address - Fax:
Practice Address - Street 1:12752 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1923
Practice Address - Country:US
Practice Address - Phone:714-636-2595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56794261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental