Provider Demographics
NPI:1013012061
Name:ABBOUD-NIEMCZYK, JEANNETTE Y (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:Y
Last Name:ABBOUD-NIEMCZYK
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 1:57 WARRIOR RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-5024
Mailing Address - Country:US
Mailing Address - Phone:610-789-1189
Mailing Address - Fax:610-789-0997
Practice Address - Street 1:57 WARRIOR RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-5024
Practice Address - Country:US
Practice Address - Phone:610-789-1189
Practice Address - Fax:610-789-0997
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-024710L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice