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General NPI Number Information
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NPI Number | 1992064919
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Entity Type | Organization
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Legal Business Name | GHIAS JABBOUR D.D.S ,PLLC
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 19179 BLANCO RD STE 106
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4043
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Country | US
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Telephone | 909-800-2539
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Fax |
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Provider Business Mailing Address
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Address Line | 19179 BLANCO RD STE 106
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4043
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Country | US
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Telephone | 909-800-2539
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GHIAS KAISAR JABBOUR
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Credential | D.D.S
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Telephone | 909-800-2539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 23094
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License Number State | TX
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