MEDICARE: DR. SABAHAT KHAN ABERNETHY DMD, CAGS

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	1223G0001X	General Practice Dentistry	21718	MA

General Provider Information

NPI Number	:	1518089903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SABAHAT KHAN ABERNETHY DMD, CAGS

Provider Business Mailing Address
First Line	:	87 JASPER LN
Second Line	:
City	:	RANDOLPH
State	:	MA
Zip	:	02368-4093
Country	:	US
Telephone Number	:	617-694-5902
Fax Number	:

Provider Business Practice Location Address
First Line	:	469 WASHINGTON ST
Second Line	:
City	:	ABINGTON
State	:	MA
Zip	:	02351-2417
Country	:	US
Telephone Number	:	781-878-2190
Fax Number	:

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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