Healthcare Provider Details

I. General information

NPI: 1255240669
Provider Name (Legal Business Name): MICHAEL ABEBE DT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 42ND AVE N
NEW HOPE MN
55427-1184
US

IV. Provider business mailing address

925 30TH AVE S APT 206
MINNEAPOLIS MN
55406-1156
US

V. Phone/Fax

Practice location:
  • Phone: 763-762-8916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125J00000X
TaxonomyDental Therapist
License NumberDT174
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: