Provider Demographics
NPI:1215569975
Name:SIMI ABRAHAM PLLC
Entity Type:Organization
Organization Name:SIMI ABRAHAM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-240-4713
Mailing Address - Street 1:2101 IRONSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4215
Mailing Address - Country:US
Mailing Address - Phone:423-240-4713
Mailing Address - Fax:
Practice Address - Street 1:4541 N JOSEY LN STE 210
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4780
Practice Address - Country:US
Practice Address - Phone:469-669-0222
Practice Address - Fax:469-669-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty