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General NPI Number Information
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NPI Number | 1679932776
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Entity Type | Organization
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Legal Business Name | B. NABA, DDS PLLC
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 9709 NORTHEAST PKWY #100
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City | MATTHEWS
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State | NC
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Zip | 28105-9705
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Country | US
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Telephone | 704-845-0500
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Fax | 704-814-0125
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Provider Business Mailing Address
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Address Line | 9709 NORTHEAST PKWY #100
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City | MATTHEWS
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State | NC
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Zip | 28105-9705
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Country | US
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Telephone | 704-845-0500
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Fax | 704-814-0125
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Authorized Official
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Title or Position | OWNER
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Name | DR. BUTHAYNA NABA
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Credential | DDS
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Telephone | 704-845-0500
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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 | 9618
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License Number State | NC
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