Provider Demographics
NPI:1902077563
Name:OMAR ABDO, DDS, MS, PA
Entity Type:Organization
Organization Name:OMAR ABDO, DDS, MS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:S
Authorized Official - Last Name:ABDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, FACP
Authorized Official - Phone:561-745-5550
Mailing Address - Street 1:200 S CENTRAL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8819
Mailing Address - Country:US
Mailing Address - Phone:561-745-5550
Mailing Address - Fax:561-745-8442
Practice Address - Street 1:200 S CENTRAL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8819
Practice Address - Country:US
Practice Address - Phone:561-745-5550
Practice Address - Fax:561-745-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL165121223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty