Provider Demographics
NPI:1336781533
Name:ABBOUD, MICHEAL (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:
Last Name:ABBOUD
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 1:1313 WASHINGTON STREET
Mailing Address - Street 2:APPARTMENT 427
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:520-370-3378
Mailing Address - Fax:
Practice Address - Street 1:1372 HANCOCK ST STE 101
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5107
Practice Address - Country:US
Practice Address - Phone:617-472-3919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist