Provider Demographics
NPI:1871891416
Name:JAMES M. ABRAHAM DMD MDS PC
Entity type:Organization
Organization Name:JAMES M. ABRAHAM DMD MDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MDS
Authorized Official - Phone:724-853-1600
Mailing Address - Street 1:4810 OLD WILLIAM PENN HIGHWAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632
Mailing Address - Country:US
Mailing Address - Phone:724-327-1122
Mailing Address - Fax:724-325-7515
Practice Address - Street 1:4810 OLD WILLIAM PENN HIGHWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:EXPORT
Practice Address - State:PA
Practice Address - Zip Code:15632
Practice Address - Country:US
Practice Address - Phone:724-327-1122
Practice Address - Fax:724-325-7515
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES M. ABRAHAM DMD MDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025341L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty