Provider Demographics
NPI:1578253639
Name:NABUT, EMILY MARIA (MBA, DMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIA
Last Name:NABUT
Suffix:
Gender:F
Credentials:MBA, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 CENTRAL AVE UNIT 474
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1628
Mailing Address - Country:US
Mailing Address - Phone:919-943-0279
Mailing Address - Fax:
Practice Address - Street 1:13200 SEMINOLE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2132
Practice Address - Country:US
Practice Address - Phone:727-223-1435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN278381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice