MEDICARE: DR. KERI ANNE ABBOTT 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	1223G0001X	General Practice Dentistry	S8062	FL
2	122300000X	Dentist	019031469	IL
3	122300000X	Dentist	D011039	AZ

General Provider Information

NPI Number	:	1841711579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERI ANNE ABBOTT DDS

Provider Business Mailing Address
First Line	:	4235 N 32ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-4766
Country	:	US
Telephone Number	:	602-610-0571
Fax Number	:

Provider Business Practice Location Address
First Line	:	4235 N 32ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-4766
Country	:	US
Telephone Number	:	602-610-0571
Fax Number	:

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

Provider Enumeration Date	:	07/03/2017
Last Update Date	:	07/16/2021

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