MEDICARE: ABM ORTHODONTICS PA

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1790642791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABM ORTHODONTICS PA

Provider Business Mailing Address
First Line	:	1180 PONCE DE LEON BLVD STE 501
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-1031
Country	:	US
Telephone Number	:	727-605-2266
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 PONCE DE LEON BLVD STE 501
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-1031
Country	:	US
Telephone Number	:	727-605-2266
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	DR. BROOKE MAHDAVI
Credential	:	DMD
Telephone Number	:	818-274-4424

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/21/2026

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Directions to “ABM ORTHODONTICS PA ” Practice Location

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