Andrew G Abdelnour, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10579 Issued in CO

Practice address

4490 W 121St Ave
Broomfield, CO 80020-5602

Phone

(303) 469-2061

Fax

(503) 471-1404

NPI assigned

Sep 17, 2008

Last updated

Apr 18, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1221609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334707200000",
    "number": "1689823346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4490 W 121ST AVE",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800205602",
            "telephone_number": "303-469-2061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4490 W 121ST AVE",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800205602",
            "telephone_number": "303-469-2061",
            "fax_number": "503-471-1404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDELNOUR",
        "first_name": "ANDREW",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-17",
        "last_updated": "2012-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "10579",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7969",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Broomfield, CO
• Providers in Broomfield, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.