Provider Demographics
NPI:1518698885
Name:ABOONA, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:ABOONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3026 FOX HILL DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3030
Mailing Address - Country:US
Mailing Address - Phone:586-612-8935
Mailing Address - Fax:
Practice Address - Street 1:11899 VISTA SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095-1715
Practice Address - Country:US
Practice Address - Phone:586-752-6596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016014361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice