Provider Demographics
NPI:1912496993
Name:ABDI, ELIAS KAMAL (DDS)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:KAMAL
Last Name:ABDI
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 1:7360 GUILFORD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5128
Mailing Address - Country:US
Mailing Address - Phone:301-668-2662
Mailing Address - Fax:301-495-0318
Practice Address - Street 1:7360 GUILFORD DR STE 102
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5128
Practice Address - Country:US
Practice Address - Phone:301-668-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-06
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD166761223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD913115900Medicaid