Provider Demographics
NPI:1043518574
Name:IMAD S ABRAHAM DDS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:IMAD S ABRAHAM DDS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-434-3310
Mailing Address - Street 1:1111 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-3001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-434-4270
Practice Address - Street 1:1111 N 19TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-3001
Practice Address - Country:US
Practice Address - Phone:610-434-3310
Practice Address - Fax:610-434-4270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028661L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024056910001Medicaid
PA0014354230004Medicaid