Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 29320 | TX |
NPI | 1114290798 |
---|---|
Provider Name | Bader Abdeen |
First Address | Katy, TX 77494-1376 |
Second Address | Katy, TX 77494-1376 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2012 |
Last Update Date | 28/04/2017 |