Provider Demographics
NPI:1225016173
Name:ANITHOTTAM, ABRAHAM JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:JOSEPH
Last Name:ANITHOTTAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 AMWELL RD
Mailing Address - Street 2:SUITE-102
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1225
Mailing Address - Country:US
Mailing Address - Phone:908-359-8100
Mailing Address - Fax:732-448-1910
Practice Address - Street 1:390 AMWELL RD
Practice Address - Street 2:SUITE-102
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1225
Practice Address - Country:US
Practice Address - Phone:908-359-8100
Practice Address - Fax:732-448-1910
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics