Healthcare Provider Details

I. General information

NPI: 1497700272
Provider Name (Legal Business Name): NABIL A ABAZA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N BROAD ST
PHILADELPHIA PA
19107-1500
US

IV. Provider business mailing address

1601 CHERRY ST SUITE 11511
PHILADELPHIA PA
19102-1321
US

V. Phone/Fax

Practice location:
  • Phone: 215-561-0562
  • Fax: 215-561-0472
Mailing address:
  • Phone: 215-255-7822
  • Fax: 215-255-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS019318L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDS019318L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: