Provider Demographics
NPI:1962823369
Name:TARBOUSH FAMILY DENTAL
Entity Type:Organization
Organization Name:TARBOUSH FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:TARBOUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-830-6766
Mailing Address - Street 1:9130 WURZBACH RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1070
Mailing Address - Country:US
Mailing Address - Phone:816-830-6766
Mailing Address - Fax:
Practice Address - Street 1:9130 WURZBACH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1070
Practice Address - Country:US
Practice Address - Phone:816-830-6766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX249691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty