Jose PH Jabboure, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

20508 Issued in OH

Practice address

4785 Leavitt Rd
Lorain, OH 44053-2136

Phone

(440) 282-6677

NPI assigned

Sep 20, 2006

Last updated

Nov 8, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA, OH2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dental Professionals Cleveland-Nouneh, Inc.

  dba bright now dental

  • Dental Clinic/Center
  • Lorain, OH
  • NPI 1821272048
  NPD (past)
• Pearl Dental Practice, Inc.

  • General Practice Dentistry
  • Strongsville, OH
  • NPI 1801143334
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1649378936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4785 LEAVITT RD",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440532136",
            "telephone_number": "440-282-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4785 LEAVITT RD",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440532136",
            "telephone_number": "440-282-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JABBOURE",
        "first_name": "JOSE",
        "middle_name": "PH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "20508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2061343",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracy B Isenberg
• Rim Soliman Ishak, MD
• Jessica Ann Isler, PTA
• Jaquietta R Isom, LPN
• Tidjani Issa
• Amaree Jackson
• Deja Jackson
• Donna Jean Jackson, CDCA
• Isabela N Jackson
• Kisha Elaine Jackson, CASE MANAGER

• General Practice Dentistry in Lorain, OH
• Providers in Lorain, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.