Provider Demographics
NPI:1417400615
Name:DAVID J. ABDO INC.PS
Entity Type:Organization
Organization Name:DAVID J. ABDO INC.PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:ABDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-435-8411
Mailing Address - Street 1:122 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1545
Mailing Address - Country:US
Mailing Address - Phone:360-435-8411
Mailing Address - Fax:360-435-7945
Practice Address - Street 1:122 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1545
Practice Address - Country:US
Practice Address - Phone:360-435-8411
Practice Address - Fax:360-435-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5813WA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty