Provider Demographics
NPI:1790166825
Name:DABBAGH, WASNA (DMD)
Entity Type:Individual
Prefix:
First Name:WASNA
Middle Name:
Last Name:DABBAGH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 MUSTIN LN
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-2014
Mailing Address - Country:US
Mailing Address - Phone:503-705-4247
Mailing Address - Fax:
Practice Address - Street 1:1041 PONTIAC RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4816
Practice Address - Country:US
Practice Address - Phone:610-446-6004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0401851223X0400X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics