Abdallah Abboud

Primary specialty

DentistTaxonomy code 122300000X

License

019028508 Issued in IL

Practice address

4049 W 26TH St
Chicago, IL 60623-3701

Phone

(773) 521-2800

Fax

(773) 521-2805

NPI assigned

Oct 25, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• First Dental Image Inc.

  dba Addison Smile

  • General Practice Dentistry
  • Addison, IL
  • NPI 1952158230
  NPD (past)
• Little Village Dental PC

  dba 1st Family Dental

  • Dentist
  • Chicago, IL
  • NPI 1720262850
  NPD (past)

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

{
    "created_epoch": "1287964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294876800000",
    "number": "1962702068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5333 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606402121",
            "telephone_number": "773-340-8318",
            "fax_number": "773-739-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4049 W 26TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606233701",
            "telephone_number": "773-521-2800",
            "fax_number": "773-521-2805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABBOUD",
        "first_name": "ABDALLAH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-25",
        "last_updated": "2011-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeff Abbott, M.D.
• Kathryn Kishi Abbott
• Ryan Abbott, DO
• Sabra Margaret Abbott, MD, PHD
• William G Abbott, DDS
• Elham Abboud, MD
• Ghassan Abboud I
• Sam Abboud
• Samir F Abboud, MD
• Abby Eve Psychotherapy, PLLC

• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2011; 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.