Provider Demographics
NPI:1093105132
Name:FIDEL ABREU DDS, PLLC
Entity Type:Organization
Organization Name:FIDEL ABREU DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON-LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-915-5228
Mailing Address - Street 1:80 GUY LOMBARDO AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3715
Mailing Address - Country:US
Mailing Address - Phone:516-223-6896
Mailing Address - Fax:516-223-2954
Practice Address - Street 1:80 GUY LOMBARDO AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3715
Practice Address - Country:US
Practice Address - Phone:516-223-6896
Practice Address - Fax:516-223-2954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty