Provider Demographics
NPI:1457507519
Name:ABOOD, MICHAEL RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:ABOOD
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 1:16128 15 MILE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026
Mailing Address - Country:US
Mailing Address - Phone:586-206-6145
Mailing Address - Fax:
Practice Address - Street 1:16128 15 MILE
Practice Address - Street 2:SUITE 4
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026
Practice Address - Country:US
Practice Address - Phone:586-206-6145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI015471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI124814788Medicaid