Nicolas Fawzi Abujamra, DDS, MS
Individual provider Active NPI Dentist · Green Bay, WI
NPI 1720123201 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720123201
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 4873-015 (WI)
- Practice address
- 2581 Development Dr
Suite 102
Green Bay, WI 54311-4247 - Phone
- (920) 347-2626
- Fax
- (920) 347-2621
- NPI assigned
- Feb 21, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 31, 2016 through Oct 31, 2026
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4873-015 | WI | MD | Dentist |
| 4873 | WI | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nicolas Abujamra DDS Ms LTD | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4873-015 | WI | Yes |
Addresses
Primary practice location
2581 Development Dr
Suite 102
Green Bay, WI 54311-4247
Mailing address
2581 Development Dr
Suite 102
Green Bay, WI 54311-4247
Phone (920) 347-2626
Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.