Healthcare Provider Details

I. General information

NPI: 1356266423
Provider Name (Legal Business Name): SHAWN ABRAHAM DENTAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 WILSHIRE BLVD
SANTA MONICA CA
90403-5509
US

IV. Provider business mailing address

1731 WILSHIRE BLVD
SANTA MONICA CA
90403-5509
US

V. Phone/Fax

Practice location:
  • Phone: 424-330-8890
  • Fax:
Mailing address:
  • Phone: 310-980-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAWN ABRAHAM
Title or Position: OWNER
Credential: DDS
Phone: 310-980-2233