Healthcare Provider Details

I. General information

NPI: 1003504598
Provider Name (Legal Business Name): ALIA MEAGAN KABBARA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 10/25/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3848 N MCKINLEY ST
CORONA CA
92879-6569
US

IV. Provider business mailing address

18392 OLD LAMPLIGHTER CIR
VILLA PARK CA
92861-4528
US

V. Phone/Fax

Practice location:
  • Phone: 951-371-2424
  • Fax:
Mailing address:
  • Phone: 714-944-3983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number108978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: