Provider Demographics
NPI:1386844231
Name:MARK ABRAMSON, D D S INC
Entity Type:Organization
Organization Name:MARK ABRAMSON, D D S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:ABRAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:650-369-9227
Mailing Address - Street 1:35 RENATO CT
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-4095
Mailing Address - Country:US
Mailing Address - Phone:650-369-9227
Mailing Address - Fax:650-369-9241
Practice Address - Street 1:424 N SAN MATEO DR STE 300
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2492
Practice Address - Country:US
Practice Address - Phone:650-369-9227
Practice Address - Fax:650-369-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258561223G0001X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA176165Medicare PIN
CA6288310001Medicare NSC
CAZZZ01711ZMedicare PIN