Healthcare Provider Details

I. General information

NPI: 1063868438
Provider Name (Legal Business Name): ABDELBAKY, ARBON & BOES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7535 CARPENTER FIRE STATION RD SUITE 201
CARY NC
27519-8617
US

IV. Provider business mailing address

8470 FALLS OF NEUSE RD SUITE 202
RALEIGH NC
27615-3500
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8947
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8431
License Number StateNC

VIII. Authorized Official

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