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General NPI Number Information
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NPI Number | 1194544270
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Entity Type | Individual
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Provider Name | ABRAHAM MATHEW DDS
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Gender | Male
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 1311 W BUSCH BLVD
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City | TAMPA
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State | FL
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Zip | 33612-7709
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Country | US
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Telephone | 813-333-0633
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Fax |
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Provider Business Mailing Address
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Address Line | 6611 ABODE AVE APT 23205
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City | TEMPLE
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State | TX
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Zip | 76502-4712
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Country | US
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Telephone | 813-843-4524
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN30965
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 41023
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License Number State | TX
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