Provider Demographics
NPI:1912621210
Name:JABBOUR, AZIZ (DMD)
Entity Type:Individual
Prefix:MR
First Name:AZIZ
Middle Name:
Last Name:JABBOUR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 STATE RTE 3
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901
Mailing Address - Country:US
Mailing Address - Phone:518-566-6400
Mailing Address - Fax:518-566-8479
Practice Address - Street 1:474 STATE RTE 3
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-566-6400
Practice Address - Fax:518-566-8479
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0627811223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY061058OtherLICENSE NUMBER NYS