Provider Demographics
NPI:1659152296
Name:JABAIEH, MAHMOUD ABDELHAKIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:ABDELHAKIM
Last Name:JABAIEH
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 1:1404 SAMBAR LOOP
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-7147
Mailing Address - Country:US
Mailing Address - Phone:805-245-9819
Mailing Address - Fax:
Practice Address - Street 1:301 W CALTON RD STE 109
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-4354
Practice Address - Country:US
Practice Address - Phone:956-320-6833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40108122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist