=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376564518
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRAJ S JABBARY DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1214 E HOUSTON ST STE D
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77327-4754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-593-3300
-----------------------------------------------------
Fax | 281-593-1616
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1214 E HOUSTON ST STE D
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77327-4754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-593-3300
-----------------------------------------------------
Fax | 281-593-1616
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 18929
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------