Provider Demographics
NPI:1568163186
Name:ABOODY, STEPHANIE (DMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ABOODY
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 1:13 WAGON WHEEL LN
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH
Mailing Address - State:ME
Mailing Address - Zip Code:04579-4474
Mailing Address - Country:US
Mailing Address - Phone:508-688-2742
Mailing Address - Fax:
Practice Address - Street 1:11 WINNERS CIR
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1727
Practice Address - Country:US
Practice Address - Phone:207-725-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEDEN5166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program