Provider Demographics
NPI:1558494344
Name:TARBOUSH, KHALED A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KHALED
Middle Name:A
Last Name:TARBOUSH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9130 WURZBACH RD
Mailing Address - Street 2:SUITE# 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1070
Mailing Address - Country:US
Mailing Address - Phone:210-384-9383
Mailing Address - Fax:210-384-9386
Practice Address - Street 1:9130 WURZBACH RD
Practice Address - Street 2:SUITE#103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1070
Practice Address - Country:US
Practice Address - Phone:210-384-9383
Practice Address - Fax:210-384-9386
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9371122300000X
TX00249691223X0008X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology