Provider Demographics
NPI:1215022199
Name:ABDO, DAVID JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:ABDO
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 1:122 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1545
Mailing Address - Country:US
Mailing Address - Phone:360-435-8411
Mailing Address - Fax:360-435-7945
Practice Address - Street 1:122 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1545
Practice Address - Country:US
Practice Address - Phone:360-435-8411
Practice Address - Fax:360-435-7945
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA58131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5813OtherSTATE LICENSE