Organization Active NPI

Elizabeth Arnett Jabbour DMD

  • Dental Clinic/Center
  • Spartanburg, SC
National Provider Identifier
1235501024
Registry record updated Oct 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
3148 Issued in SC
Legal business name
ELIZABETH ARNETT JABBOUR DMD
Practice address
402 S Pine St
Spartanburg, SC 29302-2712
Phone
(864) 582-2371
Fax
(864) 585-1949
NPI assigned
Oct 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Elizabeth Arnett Jabbour, DMD
Title
Owner/Dentist
Phone
(864) 582-2371

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 3148 SC Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

402 S Pine St
Spartanburg, SC 29302-2712

Mailing address

402 S Pine St
Spartanburg, SC 29302-2712
Phone (864) 582-2371

Other identifiers 1

IdentifierTypeStateIssuer
1407987399MedicaidSC

National Provider Directory

National Provider Directory

Locations

402 S Pine St
Spartanburg, SC 29302
Phone (864) 582-2371

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1445299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635292800000",
    "number": "1235501024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 S PINE ST",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293022712",
            "telephone_number": "864-582-2371",
            "fax_number": "864-585-1949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 S PINE ST",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293022712",
            "telephone_number": "864-582-2371",
            "fax_number": "864-585-1949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZABETH ARNETT JABBOUR DMD",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-20",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A",
        "authorized_official_last_name": "ARNETT JABBOUR",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "864-582-2371",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "SC",
            "license": "3148",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407987399",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.