Individual
DR. MARIO E ABDENNOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD MMSC
Contact information
Practice address
188 LONGWOOD AVE, BOSTON, MA 02115
(978) 505-1969
(978) 688-6465
Mailing address
75 THISTLE RD, NORTH ANDOVER, MA 01845-4745
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
19242
MA
1223E0200X
Endodontics
3244
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
X11812
BLUE CROSS & BLUE SHIELD
MA
Enumeration date
11/24/2006
Last updated
10/17/2007
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