Provider Demographics
NPI:1386766327
Name:ABBOTT, PAUL L (DMD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:ABBOTT
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 1:9710 PARK PLAZA AVE UNIT 109
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2292
Mailing Address - Country:US
Mailing Address - Phone:502-412-3309
Mailing Address - Fax:502-412-3340
Practice Address - Street 1:9710 PARK PLAZA AVE UNIT 109
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2292
Practice Address - Country:US
Practice Address - Phone:502-412-3309
Practice Address - Fax:502-412-3340
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY73751223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics