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General NPI Number Information
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NPI Number | 1063301653
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Entity Type | Individual
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Provider Name | HUSSAM JABER
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Gender | Male
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 1551 PARK PL STE 300
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City | GREEN BAY
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State | WI
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Zip | 54304-1969
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Country | US
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Telephone | 773-551-9490
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Fax |
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Provider Business Mailing Address
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Address Line | 1304 8TH ST
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City | ROCKFORD
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State | IL
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Zip | 61104-4913
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Country | US
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Telephone | 708-856-9766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6001893-15
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License Number State | WI
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