Provider Demographics
NPI:1447340310
Name:ABRAMS, RICHARD M (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:ABRAMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 GLENDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1812
Mailing Address - Country:US
Mailing Address - Phone:323-665-7665
Mailing Address - Fax:323-953-6695
Practice Address - Street 1:3311 GLENDALE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1812
Practice Address - Country:US
Practice Address - Phone:323-665-7665
Practice Address - Fax:323-953-6695
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA232721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9287001Medicaid