Provider Demographics
NPI:1366014037
Name:MORE DUARTE, ABDEL ANTONIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABDEL
Middle Name:ANTONIO
Last Name:MORE DUARTE
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 1:14025 ELDON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6527
Mailing Address - Country:US
Mailing Address - Phone:305-877-4856
Mailing Address - Fax:
Practice Address - Street 1:2335 MATTHEWS TOWNSHIP PKWY STE 111
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2403
Practice Address - Country:US
Practice Address - Phone:704-844-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC123791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice