Provider Demographics
NPI:1629451711
Name:ABAIE, KATHLEEN ASHLEY (DMD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ASHLEY
Last Name:ABAIE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ASHLEY
Other - Last Name:ABAIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4550 E BELL RD STE 106
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9342
Mailing Address - Country:US
Mailing Address - Phone:602-344-9530
Mailing Address - Fax:
Practice Address - Street 1:4550 E BELL RD STE 106
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-9342
Practice Address - Country:US
Practice Address - Phone:602-344-9530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0092351223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice