Provider Demographics
NPI:1154469443
Name:ABIDE, ANDREW ELIAS SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ELIAS
Last Name:ABIDE
Suffix:SR
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 1:637 RAYNER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-8135
Mailing Address - Country:US
Mailing Address - Phone:662-378-8606
Mailing Address - Fax:662-378-8690
Practice Address - Street 1:637 RAYNER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-8135
Practice Address - Country:US
Practice Address - Phone:662-378-8606
Practice Address - Fax:662-378-8690
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1957-821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice