Provider Demographics
NPI:1184897985
Name:ABULHOSSEINI, TABASSOM (DDS)
Entity type:Individual
Prefix:DR
First Name:TABASSOM
Middle Name:
Last Name:ABULHOSSEINI
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 1:31862 COAST HWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6769
Mailing Address - Country:US
Mailing Address - Phone:949-218-2676
Mailing Address - Fax:949-218-5352
Practice Address - Street 1:31862 COAST HWY
Practice Address - Street 2:SUITE 400
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6769
Practice Address - Country:US
Practice Address - Phone:949-218-2676
Practice Address - Fax:949-218-5352
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-12
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice