Provider Demographics
NPI:1891768495
Name:ABBEY, PAUL FREDERICK (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:FREDERICK
Last Name:ABBEY
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 1:1507 W MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3201
Mailing Address - Country:US
Mailing Address - Phone:303-678-0997
Mailing Address - Fax:303-678-0998
Practice Address - Street 1:1507 W MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3201
Practice Address - Country:US
Practice Address - Phone:303-678-0997
Practice Address - Fax:303-678-0998
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02049310Medicaid