Provider Demographics
NPI:1538370143
Name:SHUSTER, ABE (DDS)
Entity type:Individual
Prefix:DR
First Name:ABE
Middle Name:
Last Name:SHUSTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 EMORY RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2409
Mailing Address - Country:US
Mailing Address - Phone:404-373-8710
Mailing Address - Fax:
Practice Address - Street 1:999 PEACHTREE ST
Practice Address - Street 2:SUITE 710
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3915
Practice Address - Country:US
Practice Address - Phone:404-876-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA87241223P0300X
GA1223P0300X1223P0300X
GADN0087241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8724OtherLICENSE NO.
GA581314685OtherTAX ID
GA581314685OtherTAX ID