Provider Demographics
NPI:1063596435
Name:JABBAR, WIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:WIAM
Middle Name:
Last Name:JABBAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:WIAM
Other - Middle Name:A
Other - Last Name:ABDULJABBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12125 ALTA CARMEL CT STE 330
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3841
Mailing Address - Country:US
Mailing Address - Phone:858-451-0908
Mailing Address - Fax:858-451-1880
Practice Address - Street 1:12125 ALTA CARMEL CT STE 330
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3841
Practice Address - Country:US
Practice Address - Phone:858-451-0908
Practice Address - Fax:858-596-2110
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48575122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist