Healthcare Provider Details

I. General information

NPI: 1487119194
Provider Name (Legal Business Name): ABDELBAKY, ARBON & BOES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 KELLY ROAD SUITE 201
APEX NC
27502
US

IV. Provider business mailing address

P.O. BOX 603775
CHARLOTTE NC
28260-3775
US

V. Phone/Fax

Practice location:
  • Phone: 919-846-7900
  • Fax:
Mailing address:
  • Phone: 919-977-0627
  • Fax: 919-435-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHANEL PORTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 919-977-0627