Provider Demographics
NPI:1790119188
Name:ASSI, ROUBA
Entity Type:Individual
Prefix:
First Name:ROUBA
Middle Name:
Last Name:ASSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 W PLEASANT RUN RD STE 114
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1300
Mailing Address - Country:US
Mailing Address - Phone:972-227-1760
Mailing Address - Fax:
Practice Address - Street 1:1450 W PLEASANT RUN RD STE 114
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1300
Practice Address - Country:US
Practice Address - Phone:972-227-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29350122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist