Provider Demographics
NPI:1063537421
Name:ABBOUDI, AVRAHAM (DMD)
Entity type:Individual
Prefix:DR
First Name:AVRAHAM
Middle Name:
Last Name:ABBOUDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 SUSSEX RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2729
Mailing Address - Country:US
Mailing Address - Phone:201-692-1072
Mailing Address - Fax:732-875-1622
Practice Address - Street 1:3595 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3410
Practice Address - Country:US
Practice Address - Phone:718-356-1450
Practice Address - Fax:718-356-1756
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0471001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice