MEDICARE: MELVIN ABRAHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D011537	AZ

General Provider Information

NPI Number	:	1396467791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIN ABRAHAM

Provider Business Mailing Address
First Line	:	703 S CARDINAL ST
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-8932
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7350 E SPEEDWAY BLVD STE 201
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-1366
Country	:	US
Telephone Number	:	520-600-6925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	09/13/2022

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Directions to “ MELVIN ABRAHAM ” Practice Location

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