Mario E Abdennour, DMD MMSC

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

19242 Issued in MA

Practice address

188 Longwood Ave
Boston, MA 02115

Phone

(978) 505-1969

Fax

(978) 688-6465

NPI assigned

Nov 24, 2006

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

The complete record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192579200000",
    "number": "1689749574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 THISTLE RD",
            "city": "NORTH ANDOVER",
            "state": "MA",
            "postal_code": "018454745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 LONGWOOD AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02115",
            "telephone_number": "978-505-1969",
            "fax_number": "978-688-6465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDENNOUR",
        "first_name": "MARIO",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DMD MMSC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-24",
        "last_updated": "2007-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MA",
            "license": "19242",
            "primary": true
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NH",
            "license": "3244",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "X11812",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Abdelrahim
• Khaled Abdelrahman, MD
• Mohamed Abdelrahman, MD
• Eslam M Abdelwahab, DMD
• Myriam Abdennadher, M.D.
• Hodan Abdi
• Layla Abdi
• Reza Abdi, MD
• Abraham Abdin
• Fatema Abdo

• All providers in Boston, MA
• Endodontics in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.