MEDICARE: GHIAS K JABBOUR DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D8531	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790768661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GHIAS K JABBOUR DDS

Provider Business Mailing Address
First Line	:	21303 ENCINO COMMONS APT 509
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2699
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6909 N LOOP 1604 E STE 1010
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-5305
Country	:	US
Telephone Number	:	210-653-4867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	08/01/2007

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