Healthcare Provider Details

I. General information

NPI: 1275741035
Provider Name (Legal Business Name): MAE ABDALLA D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3476 GLEN ERIN DR.
MISSISSAUGA ONTARIO
L5L3R4
CA

IV. Provider business mailing address

1990 THE CHASE
MISSISSAUGA ONTARIO
L5M3A4
CA

V. Phone/Fax

Practice location:
  • Phone: 905-820-4440
  • Fax: 905-820-7712
Mailing address:
  • Phone: 416-358-1415
  • Fax: 905-569-7872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8880
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: