1336555804 NPI number — DR. SENAN ABD DMD

Table of content: DR. SENAN ABD DMD (NPI 1336555804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336555804 NPI number — DR. SENAN ABD DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABD
Provider First Name:
SENAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336555804
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1609 MAPLELEAF DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYLIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75098-8165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-223-4035
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 CYPRESS BEND PKWY
Provider Second Line Business Practice Location Address:
BUILDING A ,SUITE 3
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-290-6565
Provider Business Practice Location Address Fax Number:
469-290-6566
Provider Enumeration Date:
07/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  30080 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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