Healthcare Provider Details

I. General information

NPI: 1538807987
Provider Name (Legal Business Name): ABIGAIL SUSAN WIDMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 MERRIMAC CT
PRINCE FREDERICK MD
20678-4133
US

IV. Provider business mailing address

552 N SAINT ASAPH ST
ALEXANDRIA VA
22314-2320
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-2011
  • Fax:
Mailing address:
  • Phone: 614-905-9608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18738
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401419192
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: