Provider Demographics
NPI:1336485234
Name:D'ABADIE, JUSTIN JAY (DDS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JAY
Last Name:D'ABADIE
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 1:6500 MCNEIL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7720
Mailing Address - Country:US
Mailing Address - Phone:512-331-1477
Mailing Address - Fax:
Practice Address - Street 1:6500 MCNEIL DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-7720
Practice Address - Country:US
Practice Address - Phone:512-331-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist