Provider Demographics
NPI:1245643741
Name:ABBOUD, MARIA JOSE (DMD)
Entity type:Individual
Prefix:
First Name:MARIA JOSE
Middle Name:
Last Name:ABBOUD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MARIA JOSE
Other - Middle Name:
Other - Last Name:EL KHOURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:908 NW 57TH STREET
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-745-3927
Mailing Address - Fax:
Practice Address - Street 1:908 NW 57TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6458
Practice Address - Country:US
Practice Address - Phone:352-745-3927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist