Healthcare Provider Details

I. General information

NPI: 1194424747
Provider Name (Legal Business Name): ABRAHAM DENTAL WINONA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 TYLER HOLMES DR
WINONA MS
38967-1522
US

IV. Provider business mailing address

PO BOX 676
CALHOUN CITY MS
38916-0676
US

V. Phone/Fax

Practice location:
  • Phone: 662-283-4722
  • Fax:
Mailing address:
  • Phone: 601-720-8194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT MICHAEL ABRAHAM JR.
Title or Position: OWNER
Credential: DDS
Phone: 601-720-8194