Provider Demographics
NPI:1396843884
Name:ABREU, FIDEL (DDS PLLC)
Entity type:Individual
Prefix:
First Name:FIDEL
Middle Name:
Last Name:ABREU
Suffix:
Gender:M
Credentials:DDS PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 GUY LOMBARDO AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3715
Mailing Address - Country:US
Mailing Address - Phone:516-223-6896
Mailing Address - Fax:516-223-6854
Practice Address - Street 1:80 GUY LOMBARDO AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3715
Practice Address - Country:US
Practice Address - Phone:516-223-6896
Practice Address - Fax:516-223-2954
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047195-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01773959Medicaid