Provider Demographics
NPI:1225158280
Name:ABOU-EZZI, GEORGE A (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:ABOU-EZZI
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 1:126A PLEASANT VALLEY ST STE 4
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-7217
Mailing Address - Country:US
Mailing Address - Phone:978-688-9200
Mailing Address - Fax:978-688-4949
Practice Address - Street 1:126A PLEASANT VALLEY ST STE 4
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-7217
Practice Address - Country:US
Practice Address - Phone:978-688-9200
Practice Address - Fax:978-688-4949
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist