Emad Abdou, D.D.S.
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · North Oaks, MN
NPI 1174914766 · NPPES record last updated Jun 11, 2024
Key facts
- NPI
- 1174914766
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- License
- S209 (MN)
- Practice address
- 700 Village Center Dr Ste 170
North Oaks, MN 55127-3025 - Phone
- (651) 482-0065
- NPI assigned
- Feb 18, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 13
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Oral Surgery
- Education
- New York University College of Dentistry, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gillette Childrens Specialty Healthcare
Practice addresses (Care Compare)
200 University Ave E
Saint Paul, MN 55101-2507
Phone (651) 291-2848
Hospital & facility affiliations
- Gillette Childrens Specialty Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240620001080 | MN | Practitioner - Oral Surgery | 6608269147 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S209 | MN | MD | Oral and Maxillofacial Surgery (Dentist) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gillette Children'S Specialty Healthcare | Current |
Accepting new patients | |
| Gillette Children'S Specialty Healthcare | Current |
Accepting new patients | |
| Sioms Forest Hills Management LLC | Past |
Accepting new patients | |
| Am Dental Services P.C. | Past |
Accepting new patients | |
| Gillette Children'S Specialty Healthcare | Past |
Accepting new patients |
Locations
200 University Ave E
Saint Paul, MN 55101
Phone (651) 291-2848
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 058061 | NY | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | S209 | MN | Yes |
Addresses
Primary practice location
700 Village Center Dr Ste 170
North Oaks, MN 55127-3025
Mailing address
256-C Mason Ave. 3Rd Floor
Staten Island, NY 10305
Phone (718) 226-1251
Other practice location 1
256C Mason Ave 3rd floor
Staten Island, NY 10305
Phone (718) 226-1251
Other practice location 2
7009 Austin St Ste 201
Forest Hills, NY 11375-1012
Phone (718) 261-2790
Other providers in North Oaks, MN
- Youmna Walid Ahmed
- Susan McClellan Asch
- Brian J Devoe DDS PA
- Brookdale Senior Living Communities, Inc.
- Conrad Eye Services, PLC
All providers in North Oaks, MN · Oral and Maxillofacial Surgery (Dentist) in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.