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General NPI Number Information
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NPI Number | 1477082519
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Entity Type | Individual
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Provider Name | AMINE KADDOUR-DJEBBAR
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Gender | Male
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Dates
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Enumeration Date | 06/11/2017
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Last Update Date | 06/16/2017
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Provider Practice Location Address
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Address Line | 7807 MCPHERSON RD
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City | LAREDO
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State | TX
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Zip | 78045-2813
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Country | US
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Telephone | 832-495-1643
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Fax |
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Provider Business Mailing Address
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Address Line | 14919 TWISTING OAK ST
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City | HOUSTON
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State | TX
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Zip | 77082
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 33062
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License Number State | TX
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