Provider Demographics
NPI:1952538761
Name:NEW ENGLAND DENTAL SPECIALISTS
Entity Type:Organization
Organization Name:NEW ENGLAND DENTAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST AND IMPLANT SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:S
Authorized Official - Last Name:ABBOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MIPS
Authorized Official - Phone:909-289-9034
Mailing Address - Street 1:333 RICCIUTI DR
Mailing Address - Street 2:1003
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6287
Mailing Address - Country:US
Mailing Address - Phone:909-289-9034
Mailing Address - Fax:
Practice Address - Street 1:758 ASHLEY BLVD
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-5546
Practice Address - Country:US
Practice Address - Phone:508-998-3566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty