Provider Demographics
NPI:1104921014
Name:ABAY, EMELINE BELEN (DMD)
Entity type:Individual
Prefix:
First Name:EMELINE
Middle Name:BELEN
Last Name:ABAY
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 1:3305 E DOUGLAS AVE
Mailing Address - Street 2:STE. 201
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1036
Mailing Address - Country:US
Mailing Address - Phone:316-686-4321
Mailing Address - Fax:316-686-5335
Practice Address - Street 1:3305 E DOUGLAS AVE
Practice Address - Street 2:STE. 201
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1036
Practice Address - Country:US
Practice Address - Phone:316-686-4321
Practice Address - Fax:316-686-5335
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS65541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS822705OtherUNITED CONCORDIA
KS17385OtherBCBSKS