Provider Demographics
NPI:1609980309
Name:YAMMINE, YAMMINE GABRIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:YAMMINE
Middle Name:GABRIEL
Last Name:YAMMINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:GABRIEL
Other - Middle Name:
Other - Last Name:YAMMINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1640 FOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2402
Mailing Address - Country:US
Mailing Address - Phone:713-697-4000
Mailing Address - Fax:281-715-2188
Practice Address - Street 1:1640 FOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-2402
Practice Address - Country:US
Practice Address - Phone:713-697-4000
Practice Address - Fax:281-715-2188
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205751223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167801301Medicaid