Provider Demographics
NPI:1033349550
Name:ABAKAH, RICARDO MENSAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:MENSAH
Last Name:ABAKAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC BOX 20130 CAMP LEJEUNE, NC
Mailing Address - Street 2:COMMANDING OFFICER 2D DENBN/NDC
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28542
Mailing Address - Country:US
Mailing Address - Phone:910-451-2208
Mailing Address - Fax:910-451-8036
Practice Address - Street 1:110 NNPTC COMMAND CIRCLE
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445
Practice Address - Country:US
Practice Address - Phone:843-794-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1379939577OtherTRICARE