Provider Demographics
NPI:1821855503
Name:DABBAGH, YOUSSEF
Entity Type:Individual
Prefix:
First Name:YOUSSEF
Middle Name:
Last Name:DABBAGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17570 RINALDI ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-3318
Mailing Address - Country:US
Mailing Address - Phone:818-447-1372
Mailing Address - Fax:
Practice Address - Street 1:11026 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5007
Practice Address - Country:US
Practice Address - Phone:818-363-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist