=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013600998
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIE ABBOUD DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2023
-----------------------------------------------------
Last Update Date | 05/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 WILKESBORO BLVD NE
-----------------------------------------------------
City | LENOIR
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28645-4610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-754-3531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 661 PERRILYN ST
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15226-1450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-897-9188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 13215
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------