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General NPI Number Information
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NPI Number | 1659750925
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Entity Type | Organization
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Legal Business Name | MICHAEL A. ABRAHAM D.M.D., PA
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 4719 N OCEAN DR
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City | LAUDERDALE BY THE SEA
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State | FL
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Zip | 33308-2914
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Country | US
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Telephone | 303-819-6371
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Fax |
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Provider Business Mailing Address
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Address Line | 4719 N OCEAN DR
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City | LAUDERDALE BY THE SEA
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State | FL
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Zip | 33308-2914
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Country | US
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Telephone | 303-819-6371
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL ALEXANDER ABRAHAM
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Credential | DMD
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Telephone | 303-819-6371
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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 | DN19695
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License Number State | FL
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