Provider Demographics
NPI:1790967958
Name:ALKABBANI, BASHAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BASHAR
Middle Name:
Last Name:ALKABBANI
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 1:6545 FRANCE AVE S STE 681
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2127
Mailing Address - Country:US
Mailing Address - Phone:612-800-8008
Mailing Address - Fax:612-354-3015
Practice Address - Street 1:6545 FRANCE AVE S STE 681
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2127
Practice Address - Country:US
Practice Address - Phone:612-800-8008
Practice Address - Fax:612-354-3015
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist