Provider Demographics
NPI:1407919400
Name:ABITBOL, THIERRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:THIERRY
Middle Name:
Last Name:ABITBOL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3377 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5030
Mailing Address - Country:US
Mailing Address - Phone:516-766-0732
Mailing Address - Fax:516-678-5067
Practice Address - Street 1:3377 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5030
Practice Address - Country:US
Practice Address - Phone:516-766-0732
Practice Address - Fax:516-678-5067
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0426281223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics