=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619048105
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD BRUCE ABRAMS D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2030 TERRY ST STE B SUITE B
-----------------------------------------------------
City | LONGMONT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80501-1889
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-651-3733
-----------------------------------------------------
Fax | 303-485-5380
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 JASMINE CIR
-----------------------------------------------------
City | BOULDER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80304-1713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-442-1206
-----------------------------------------------------
Fax | 303-442-3093
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 6509
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------