Active NPI
Aziz Jabbour, D.M.D.
- Dentist
- Plattsburgh, NY
National Provider Identifier
1912621210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 062781
- Practice address
- 474 State Rte 3
Plattsburgh, NY 12901 - Phone
- (518) 566-6400
- Fax
- (518) 566-8479
- NPI assigned
- Sep 29, 2022
- Last updated
- Apr 3, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 062781 | NY | Primary |
| General Practice Dentistry | 1223G0001X | 062781 | NY |
Addresses
Primary practice location
474 State Rte 3
Plattsburgh, NY 12901
Mailing address
474 State Rte 3
Plattsburgh, NY 12901
Phone (518) 566-6400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 061058 | Other | NY | LICENSE NUMBER NYS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 062781 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680480000000",
"number": "1912621210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "474 STATE RTE 3",
"city": "PLATTSBURGH",
"state": "NY",
"postal_code": "12901",
"telephone_number": "518-566-6400",
"fax_number": "518-566-8479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "474 STATE RTE 3",
"city": "PLATTSBURGH",
"state": "NY",
"postal_code": "12901",
"telephone_number": "518-566-6400",
"fax_number": "518-566-8479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JABBOUR",
"first_name": "AZIZ",
"name_prefix": "Mr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-09-29",
"last_updated": "2023-04-03",
"certification_date": "2023-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "062781",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "062781",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER NYS",
"identifier": "061058",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Plattsburgh, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.