Provider Demographics
NPI:1760185656
Name:NIZAM JABBOUR DDS PC
Entity Type:Organization
Organization Name:NIZAM JABBOUR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:NIZAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JABBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:845-454-0560
Mailing Address - Street 1:2 CLARINBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-3325
Mailing Address - Country:US
Mailing Address - Phone:845-454-0560
Mailing Address - Fax:
Practice Address - Street 1:153 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4567
Practice Address - Country:US
Practice Address - Phone:845-454-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty