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General NPI Number Information
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NPI Number | 1043518574
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Entity Type | Organization
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Legal Business Name | IMAD S ABRAHAM DDS FAMILY DENTISTRY
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Dates
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Enumeration Date | 03/08/2011
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Last Update Date | 12/05/2018
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Provider Practice Location Address
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Address Line | 1111 N 19TH ST
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City | ALLENTOWN
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State | PA
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Zip | 18104-3001
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Country | US
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Telephone | 610-434-3310
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Fax | 610-434-4270
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Provider Business Mailing Address
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Address Line | 1111 N 19TH ST
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City | ALLENTOWN
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State | PA
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Zip | 18104-3001
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Country | US
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Telephone |
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Fax | 610-434-4270
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | IMAD ABRAHAM
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Credential | DDS
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Telephone | 610-434-3310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS028661L
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License Number State | PA
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