Provider Demographics
NPI:1376089078
Name:ABOU-RASS, TEDIE LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:TEDIE
Middle Name:LYNN
Last Name:ABOU-RASS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TEDIE
Other - Middle Name:LYNN
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2870 PINELAWN DR
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1348
Mailing Address - Country:US
Mailing Address - Phone:626-523-7490
Mailing Address - Fax:
Practice Address - Street 1:2870 PINELAWN DR
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-1348
Practice Address - Country:US
Practice Address - Phone:626-523-7490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist