Provider Demographics
NPI:1841499340
Name:ABIDE, ANDREW ELIAS JR (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ELIAS
Last Name:ABIDE
Suffix:JR
Gender:M
Credentials:DMD
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Mailing Address - Street 1:5740 GETWELL RD
Mailing Address - Street 2:BLD 3, UNIT A
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6346
Mailing Address - Country:US
Mailing Address - Phone:662-470-5811
Mailing Address - Fax:662-470-5817
Practice Address - Street 1:5740 GETWELL RD
Practice Address - Street 2:BLD 3, UNIT A
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-6346
Practice Address - Country:US
Practice Address - Phone:662-470-5811
Practice Address - Fax:662-470-5817
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS3573-10122300000X
MSENDO-441-111223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist