Provider Demographics
NPI:1194863084
Name:ABRAMOV, ILIA (DDS)
Entity Type:Individual
Prefix:
First Name:ILIA
Middle Name:
Last Name:ABRAMOV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2198 BARNES AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-1902
Mailing Address - Country:US
Mailing Address - Phone:718-863-4141
Mailing Address - Fax:877-202-2090
Practice Address - Street 1:2198 BARNES AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-1902
Practice Address - Country:US
Practice Address - Phone:718-863-4141
Practice Address - Fax:877-202-2090
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052493-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice