MEDICARE: DR. FAITH M ABOONA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901020756	MI

General Provider Information

NPI Number	:	1336404979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAITH M ABOONA DDS

Provider Business Mailing Address
First Line	:	49202 E WOODS DR
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48317-1850
Country	:	US
Telephone Number	:	248-854-0618
Fax Number	:

Provider Business Practice Location Address
First Line	:	64845 VAN DYKE RD
Second Line	:	#3
City	:	WASHINGTON
State	:	MI
Zip	:	48095-2836
Country	:	US
Telephone Number	:	586-752-6596
Fax Number	:	586-752-5471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	08/20/2014

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