Provider Demographics
NPI:1144412032
Name:ABRAHAM, PRIYA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:M
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 PROSPECT PL
Mailing Address - Street 2:APT 3L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4266
Mailing Address - Country:US
Mailing Address - Phone:410-746-8358
Mailing Address - Fax:
Practice Address - Street 1:3505 DAIRY VALLEY TRL
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3746
Practice Address - Country:US
Practice Address - Phone:410-746-8358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053422122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist