Healthcare Provider Details

I. General information

NPI: 1912496993
Provider Name (Legal Business Name): ELIAS KAMAL ABDI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2018
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7360 GUILFORD DR STE 102
FREDERICK MD
21704-5128
US

IV. Provider business mailing address

7360 GUILFORD DR STE 102
FREDERICK MD
21704-5128
US

V. Phone/Fax

Practice location:
  • Phone: 301-668-2662
  • Fax:
Mailing address:
  • Phone: 301-668-2662
  • Fax: 301-495-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number16676
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number16676
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: