Provider Demographics
NPI:1205503448
Name:ABIED, ABANOJOSEPH SAMUEL (DDS)
Entity type:Individual
Prefix:DR
First Name:ABANOJOSEPH
Middle Name:SAMUEL
Last Name:ABIED
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 1:815 WATER ST APT B1811
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5412
Mailing Address - Country:US
Mailing Address - Phone:347-291-7748
Mailing Address - Fax:
Practice Address - Street 1:15148 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1817
Practice Address - Country:US
Practice Address - Phone:813-257-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN263851223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics