Provider Demographics
NPI:1952854176
Name:ABBASSI, SUMMY
Entity Type:Individual
Prefix:DR
First Name:SUMMY
Middle Name:
Last Name:ABBASSI
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 1:5807 TOPANGA CANYON BLVD APT B308
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4657
Mailing Address - Country:US
Mailing Address - Phone:818-930-6190
Mailing Address - Fax:
Practice Address - Street 1:19458 VENTURA BLVD STE 10
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3037
Practice Address - Country:US
Practice Address - Phone:818-930-6190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist