Provider Demographics
NPI:1639759863
Name:KWAK, ABBY MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABBY
Middle Name:MARIE
Last Name:KWAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ABBY
Other - Middle Name:MARIE
Other - Last Name:SCHABEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5150 N PORT WASHINGTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5400
Mailing Address - Country:US
Mailing Address - Phone:414-964-8850
Mailing Address - Fax:
Practice Address - Street 1:5150 N PORT WASHINGTON RD STE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-5400
Practice Address - Country:US
Practice Address - Phone:414-964-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002581-15122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist