Provider Demographics
NPI:1558340976
Name:BARSOUM, BADR FADEL (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:BADR
Middle Name:FADEL
Last Name:BARSOUM
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2641
Mailing Address - Country:US
Mailing Address - Phone:626-287-8103
Mailing Address - Fax:626-285-2646
Practice Address - Street 1:2326 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2641
Practice Address - Country:US
Practice Address - Phone:626-287-8103
Practice Address - Fax:626-285-2646
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist