Healthcare Provider Details

I. General information

NPI: 1174457329
Provider Name (Legal Business Name): ABRAHIM ALI ABU-HANTASH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 ARMORY RD
BARSTOW CA
92311-5460
US

IV. Provider business mailing address

923 ARMORY RD
BARSTOW CA
92311-5460
US

V. Phone/Fax

Practice location:
  • Phone: 760-252-4488
  • Fax:
Mailing address:
  • Phone: 760-252-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: