Provider Demographics
NPI:1609519727
Name:ABDI, HASSIBA (DDS)
Entity Type:Individual
Prefix:DR
First Name:HASSIBA
Middle Name:
Last Name:ABDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 PARK MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2518
Mailing Address - Country:US
Mailing Address - Phone:785-691-7311
Mailing Address - Fax:
Practice Address - Street 1:4907 PARK MEADOWS LN
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2518
Practice Address - Country:US
Practice Address - Phone:785-691-7311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-16
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401418088122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program