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General NPI Number Information
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NPI Number | 1598487621
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Entity Type | Individual
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Provider Name | TASNIM ABUTABIKH DMD
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Gender | Female
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Dates
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Enumeration Date | 09/15/2022
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 2150 N JOSEY LN STE 306
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City | CARROLLTON
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State | TX
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Zip | 75006-3000
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Country | US
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Telephone | 972-820-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 11 DELL AVE
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City | MEDFORD
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State | MA
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Zip | 02155-2056
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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 | DN1859584
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 41242
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License Number State | TX
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