Healthcare Provider Details

I. General information

NPI: 1962333492
Provider Name (Legal Business Name): MAHDI BUABBAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 PATTERSON RD
DAYTON OH
45419-4308
US

IV. Provider business mailing address

425 PATTERSON RD
DAYTON OH
45419-4308
US

V. Phone/Fax

Practice location:
  • Phone: 614-816-6661
  • Fax:
Mailing address:
  • Phone: 614-816-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberUE758477
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: