Provider Demographics
NPI:1639339724
Name:ABAZID, BASSAM ABDULNAIM (DDS)
Entity type:Individual
Prefix:DR
First Name:BASSAM
Middle Name:ABDULNAIM
Last Name:ABAZID
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 BABCOCK RD STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2482
Mailing Address - Country:US
Mailing Address - Phone:210-561-9999
Mailing Address - Fax:210-561-9998
Practice Address - Street 1:5910 BABCOCK RD STE 205
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-2482
Practice Address - Country:US
Practice Address - Phone:210-561-9999
Practice Address - Fax:210-561-9998
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX260951223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty