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General NPI Number Information
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NPI Number | 1700631538
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Entity Type | Organization
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Legal Business Name | PANHAM PLLC
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 1612 53RD AVE E
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City | BRADENTON
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State | FL
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Zip | 34203-4252
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Country | US
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Telephone | 941-758-3999
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Fax |
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Provider Business Mailing Address
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Address Line | 5460 LENA RD UNIT 102
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City | BRADENTON
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State | FL
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Zip | 34211-9500
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Country | US
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Telephone | 941-755-6637
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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. 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 | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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