Provider Demographics
NPI:1679953111
Name:JABER, YAZAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:YAZAN
Middle Name:
Last Name:JABER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:YAZAN
Other - Middle Name:
Other - Last Name:JABR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1717 OLYMPIA WAY
Mailing Address - Street 2:#108
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-636-1900
Mailing Address - Fax:
Practice Address - Street 1:1717 OLYMPIA WAY
Practice Address - Street 2:3108
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-636-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WADE607240941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program