Provider Demographics
NPI:1730432303
Name:ABBOUD, MARCUS (DDS)
Entity type:Individual
Prefix:PROF
First Name:MARCUS
Middle Name:
Last Name:ABBOUD
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 1:11 CLUB HOUSE CT
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1041
Mailing Address - Country:US
Mailing Address - Phone:631-388-2372
Mailing Address - Fax:
Practice Address - Street 1:1104 WESTCHESTER HL
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8706
Practice Address - Country:US
Practice Address - Phone:631-632-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0000321223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics