Provider Demographics
NPI:1639299985
Name:ABDEH, ADAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:ABDEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 LARKIN DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4929
Mailing Address - Country:US
Mailing Address - Phone:914-815-7414
Mailing Address - Fax:845-782-0336
Practice Address - Street 1:340 LARKIN DR STE 201
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-4929
Practice Address - Country:US
Practice Address - Phone:914-815-7414
Practice Address - Fax:845-782-0336
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0528071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02851710Medicaid