Provider Demographics
NPI:1649000423
Name:ABOUDAN, AHMAD HIKMAT
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:HIKMAT
Last Name:ABOUDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 DUNWOODY PARK APT 2310
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7957
Mailing Address - Country:US
Mailing Address - Phone:312-890-8004
Mailing Address - Fax:
Practice Address - Street 1:2706 RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7328
Practice Address - Country:US
Practice Address - Phone:337-944-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX409471223X0400X
LA76191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics