Healthcare Provider Details

I. General information

NPI: 1629861307
Provider Name (Legal Business Name): ELI ABBO DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 NE 163RD ST
NORTH MIAMI BEACH FL
33160-4462
US

IV. Provider business mailing address

3031 NE 163RD ST
NORTH MIAMI BEACH FL
33160-4462
US

V. Phone/Fax

Practice location:
  • Phone: 305-945-0909
  • Fax: 305-945-0907
Mailing address:
  • Phone: 305-945-0909
  • Fax: 305-945-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE GUTIERREZ
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 305-945-0909