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General NPI Number Information
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NPI Number | 1194424747
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Entity Type | Organization
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Legal Business Name | ABRAHAM DENTAL WINONA, PLLC
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Dates
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Enumeration Date | 03/02/2023
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Last Update Date | 03/02/2023
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Provider Practice Location Address
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Address Line | 412 TYLER HOLMES DR
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City | WINONA
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State | MS
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Zip | 38967-1522
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Country | US
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Telephone | 662-283-4722
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 676
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City | CALHOUN CITY
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State | MS
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Zip | 38916-0676
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Country | US
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Telephone | 601-720-8194
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT MICHAEL ABRAHAM JR.
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Credential | DDS
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Telephone | 601-720-8194
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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 |
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License Number State |
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