Healthcare Provider Details

I. General information

NPI: 1821752981
Provider Name (Legal Business Name): HANNAH MACKENZIE KIDD ABDO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2D DENBN/NDC, PSC 20130 315 MCHUGH BLVD
CAMP LEJEUNE NC
28542-0130
US

IV. Provider business mailing address

2DENBN/NDC CAMP LEJEUNE, PSC BOX 20130 315 MCHUGH BLVD
CAMP LEJEUNE NC
28542
US

V. Phone/Fax

Practice location:
  • Phone: 910-451-2208
  • Fax:
Mailing address:
  • Phone: 910-451-1658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN26200
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN26200
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13661
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: