Healthcare Provider Details

I. General information

NPI: 1457507519
Provider Name (Legal Business Name): MICHAEL RICHARD ABOOD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16128 15 MILE SUITE 4
FRASER MI
48026
US

IV. Provider business mailing address

16128 15 MILE SUITE 4
FRASER MI
48026
US

V. Phone/Fax

Practice location:
  • Phone: 586-206-6145
  • Fax:
Mailing address:
  • Phone: 586-206-6145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number015471
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: