Healthcare Provider Details

I. General information

NPI: 1386274579
Provider Name (Legal Business Name): WIAM JABBAR, D.D.S.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12125 ALTA CARMEL CT STE 330
SAN DIEGO CA
92128-3841
US

IV. Provider business mailing address

12125 ALTA CARMEL CT STE 330
SAN DIEGO CA
92128-3841
US

V. Phone/Fax

Practice location:
  • Phone: 858-451-0908
  • Fax: 858-451-1880
Mailing address:
  • Phone: 858-451-0908
  • Fax: 858-451-1880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WIAM JABBAR
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 858-451-0908