Provider Demographics
NPI:1942675848
Name:ABBAS DENTAL CORPORATION
Entity Type:Organization
Organization Name:ABBAS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYTHAM
Authorized Official - Middle Name:MADEL
Authorized Official - Last Name:ABBAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-384-5579
Mailing Address - Street 1:3880 TRUXEL RD STE 500
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3615
Mailing Address - Country:US
Mailing Address - Phone:916-384-5579
Mailing Address - Fax:
Practice Address - Street 1:3880 TRUXEL RD STE 600
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3615
Practice Address - Country:US
Practice Address - Phone:916-384-5579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9017952Medicare PIN