Provider Demographics
NPI:1639267594
Name:JABBOUR, HANI R (DMD)
Entity Type:Individual
Prefix:DR
First Name:HANI
Middle Name:R
Last Name:JABBOUR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LA CASA VIA STE 102
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3013
Mailing Address - Country:US
Mailing Address - Phone:925-930-8465
Mailing Address - Fax:925-930-9955
Practice Address - Street 1:108 LA CASA VIA STE 102
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3013
Practice Address - Country:US
Practice Address - Phone:925-930-8465
Practice Address - Fax:925-930-9955
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice