MEDICARE: DAVID ABOU-EZZI

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	DN1859427	MA

General Provider Information

NPI Number	:	1639817257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ABOU-EZZI

Provider Business Mailing Address
First Line	:	55 SHERWOOD DR
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-3247
Country	:	US
Telephone Number	:	508-801-4903
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 TURNPIKE ST STE 55
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-5935
Country	:	US
Telephone Number	:	978-685-5562
Fax Number	:

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

Provider Enumeration Date	:	05/24/2022
Last Update Date	:	08/02/2022

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