Provider Demographics
NPI:1538734934
Name:ABBOUD, YASMEEN (DMD)
Entity type:Individual
Prefix:
First Name:YASMEEN
Middle Name:
Last Name:ABBOUD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 FISK RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3378
Mailing Address - Country:US
Mailing Address - Phone:973-444-7959
Mailing Address - Fax:
Practice Address - Street 1:1320 FAIRVIEW BLVD STE B
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-2036
Practice Address - Country:US
Practice Address - Phone:856-764-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN249211223X0400X
NJ22DI028130001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics