Provider Demographics
NPI:1285968164
Name:Z KASSAB N MUBARAKA DDS INC
Entity type:Organization
Organization Name:Z KASSAB N MUBARAKA DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-481-8990
Mailing Address - Street 1:9635 MILLIKEN AVE
Mailing Address - Street 2:STE # 103
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-9004
Mailing Address - Country:US
Mailing Address - Phone:909-481-8990
Mailing Address - Fax:
Practice Address - Street 1:9635 MILLIKEN AVE
Practice Address - Street 2:STE # 103
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-9004
Practice Address - Country:US
Practice Address - Phone:909-481-8990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49556261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental