Provider Demographics
NPI:1164515128
Name:ABDAL, NIDAA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIDAA
Middle Name:A
Last Name:ABDAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30890 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2606
Mailing Address - Country:US
Mailing Address - Phone:248-478-0900
Mailing Address - Fax:248-855-0613
Practice Address - Street 1:30890 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2606
Practice Address - Country:US
Practice Address - Phone:248-478-0900
Practice Address - Fax:248-855-0613
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010176201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4465023Medicaid