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General NPI Number Information
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NPI Number | 1427661958
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Entity Type | Individual
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Provider Name | ABDO ISMAIL DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 08/13/2023
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Provider Practice Location Address
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Address Line | 3806 E BROAD ST STE 108
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City | MANSFIELD
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State | TX
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Zip | 76063-5621
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Country | US
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Telephone | 817-799-5969
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Fax |
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Provider Business Mailing Address
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Address Line | 726 CRYSTAL OAK LN
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City | ARLINGTON
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State | TX
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Zip | 76005-4614
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Country | US
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Telephone | 832-526-1060
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 39914
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License Number State | TX
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