MEDICARE: KURIAN ABRAHAM D.D.S.

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	1223G0001X	General Practice Dentistry	DS020608L	PA

General Provider Information

NPI Number	:	1609078740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURIAN ABRAHAM D.D.S.

Provider Business Mailing Address
First Line	:	1825 SPRING GARDEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 SPRING GARDEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3916
Country	:	US
Telephone Number	:	215-972-0955
Fax Number	:

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

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	07/08/2007

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