Healthcare Provider Details

I. General information

NPI: 1619809605
Provider Name (Legal Business Name): ABRAHAM DABBAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 W CAMELBACK RD
PHOENIX AZ
85013-2177
US

IV. Provider business mailing address

4023 E DEVONSHIRE AVE
PHOENIX AZ
85018-4109
US

V. Phone/Fax

Practice location:
  • Phone: 707-327-9703
  • Fax:
Mailing address:
  • Phone: 707-327-9703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012816
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: