Provider Demographics
NPI:1255624953
Name:TAMMAM SHEABAR DDS, INC
Entity type:Organization
Organization Name:TAMMAM SHEABAR DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEABAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-597-2444
Mailing Address - Street 1:27725 SANTA MARGARITA PKY
Mailing Address - Street 2:#261
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-597-2444
Mailing Address - Fax:949-597-2414
Practice Address - Street 1:27725 SANTA MARGARITA PKY
Practice Address - Street 2:#261
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-597-2444
Practice Address - Fax:949-597-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty