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General NPI Number Information
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NPI Number | 1730792359
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Entity Type | Individual
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Provider Name | JASON ABRAHAM DMD
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Gender | Male
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 4243 AMBASSADOR CAFFERY PKWY STE 118
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City | LAFAYETTE
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State | LA
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Zip | 70508-7268
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Country | US
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Telephone | 337-422-3587
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Fax |
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Provider Business Mailing Address
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Address Line | 3815 TIMBERS EDGE LN
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City | GLENVIEW
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State | IL
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Zip | 60025-1480
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Country | US
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Telephone |
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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 | 019032886
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License Number State | IL
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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 | 600136815
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7634
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License Number State | LA
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