Provider Demographics
NPI:1639817257
Name:ABOU-EZZI, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ABOU-EZZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-3247
Mailing Address - Country:US
Mailing Address - Phone:508-801-4903
Mailing Address - Fax:
Practice Address - Street 1:555 TURNPIKE ST STE 55
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5935
Practice Address - Country:US
Practice Address - Phone:978-685-5562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist