Provider Demographics
NPI:1609941210
Name:DABBOUSI, MOHAMMAD WALID (DDS)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:WALID
Last Name:DABBOUSI
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 1:10253 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780
Mailing Address - Country:US
Mailing Address - Phone:626-448-6581
Mailing Address - Fax:
Practice Address - Street 1:401 NORTH GARFIELD AVENUE
Practice Address - Street 2:SUITE # 5
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801
Practice Address - Country:US
Practice Address - Phone:626-570-0974
Practice Address - Fax:626-570-0735
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist