Provider Demographics
NPI:1972012995
Name:ABU-TABRA, INAS TALIB KSHASH (DDS)
Entity Type:Individual
Prefix:
First Name:INAS
Middle Name:TALIB KSHASH
Last Name:ABU-TABRA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12655 W HOUSTON CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2756
Mailing Address - Country:US
Mailing Address - Phone:832-298-2132
Mailing Address - Fax:
Practice Address - Street 1:9824 FONDREN RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-3648
Practice Address - Country:US
Practice Address - Phone:832-376-8453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice