Healthcare Provider Details

I. General information

NPI: 1780638890
Provider Name (Legal Business Name): PATRICK A ABBEY D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 E. FLETCHER AVE STE 100 ORAL & MAXILLOFACIAL SURGERY
TAMPA FL
33613
US

IV. Provider business mailing address

3000 E FLETCHER AVE SUITE 100
TAMPA FL
33613-4656
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-4099
  • Fax: 813-972-4920
Mailing address:
  • Phone: 813-972-4099
  • Fax: 813-972-4920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN11919
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: