=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083808125
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | G E DEBBANEH DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2007
-----------------------------------------------------
Last Update Date | 08/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 927 N LA BREA AVE
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90302-2207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-330-9200
-----------------------------------------------------
Fax | 310-330-9220
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 927 N LA BREA AVE
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-330-9200
-----------------------------------------------------
Fax | 310-330-9220
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | DR. GEORGE DEBBANEH
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 310-330-9200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 34083
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------