Provider Demographics
NPI:1275741035
Name:ABDALLA, MAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAE
Middle Name:
Last Name:ABDALLA
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 1:1990 THE CHASE
Mailing Address - Street 2:
Mailing Address - City:MISSISSAUGA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L5M3A4
Mailing Address - Country:CA
Mailing Address - Phone:416-358-1415
Mailing Address - Fax:905-569-7872
Practice Address - Street 1:3476 GLEN ERIN DR.
Practice Address - Street 2:
Practice Address - City:MISSISSAUGA
Practice Address - State:ONTARIO
Practice Address - Zip Code:L5L3R4
Practice Address - Country:CA
Practice Address - Phone:905-820-4440
Practice Address - Fax:905-820-7712
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO88801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice