Provider Demographics
NPI:1104077502
Name:DE ANNA, ABEL O (DMD)
Entity type:Individual
Prefix:DR
First Name:ABEL
Middle Name:O
Last Name:DE ANNA
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 1:2901 S BAYSHORE DR
Mailing Address - Street 2:APT 4F
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-6001
Mailing Address - Country:US
Mailing Address - Phone:305-505-4768
Mailing Address - Fax:
Practice Address - Street 1:12700 SW 128TH ST STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5378
Practice Address - Country:US
Practice Address - Phone:786-206-8003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL77841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice