Provider Demographics
NPI:1770506123
Name:ABATI, MARIO JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:JAMES
Last Name:ABATI
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 1:2130 WILLIAMSBRIDGE RD
Mailing Address - Street 2:1H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1619
Mailing Address - Country:US
Mailing Address - Phone:718-792-1000
Mailing Address - Fax:718-792-3672
Practice Address - Street 1:2130 WILLIAMSBRIDGE RD
Practice Address - Street 2:1H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1619
Practice Address - Country:US
Practice Address - Phone:718-792-1000
Practice Address - Fax:718-792-3672
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026795122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist