Provider Demographics
NPI:1679932776
Name:B. NABA, DDS PLLC
Entity type:Organization
Organization Name:B. NABA, DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BUTHAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NABA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-845-0500
Mailing Address - Street 1:9709 NORTHEAST PKWY
Mailing Address - Street 2:#100
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-9705
Mailing Address - Country:US
Mailing Address - Phone:704-845-0500
Mailing Address - Fax:704-814-0125
Practice Address - Street 1:9709 NORTHEAST PKWY
Practice Address - Street 2:#100
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-9705
Practice Address - Country:US
Practice Address - Phone:704-845-0500
Practice Address - Fax:704-814-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9618122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty