MEDICARE: CHRISTINA YASAMAN SABOUR DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	27578	TX

General Provider Information

NPI Number	:	1255627089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA YASAMAN SABOUR DDS

Provider Business Mailing Address
First Line	:	631 FAIRWAY VIEW TER
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-9550
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2261 OLYMPIA DR STE 300
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1857
Country	:	US
Telephone Number	:	214-285-5900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	11/21/2024

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