Provider Demographics
NPI:1629213657
Name:YAHYA JABER DENTAL CORP
Entity Type:Organization
Organization Name:YAHYA JABER DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YAHYA
Authorized Official - Middle Name:SULIEMAN
Authorized Official - Last Name:JABER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-486-0550
Mailing Address - Street 1:12190 PERRIS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-7422
Mailing Address - Country:US
Mailing Address - Phone:951-486-0550
Mailing Address - Fax:951-486-0566
Practice Address - Street 1:12190 PERRIS BLVD STE D
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-7422
Practice Address - Country:US
Practice Address - Phone:951-486-0550
Practice Address - Fax:951-486-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA275395OtherUNITED CONCORDIA
CA31785OtherSAFEHEALTH LIFE INSURANCE COMPANY
CAB44184-01OtherDELTA DENTAL HEALTHY FAMILIES
CAB44189-01OtherDENTICAL
CA2058225OtherBLUE CROSS BLUE SHIELD OF TENNESSEE