Provider Demographics
NPI:1396033213
Name:ABRAHAMS, ADRIAN EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:EDWARD
Last Name:ABRAHAMS
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 1:1221 DUNLAWTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-8930
Mailing Address - Country:US
Mailing Address - Phone:386-304-1181
Mailing Address - Fax:
Practice Address - Street 1:1221 DUNLAWTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-8930
Practice Address - Country:US
Practice Address - Phone:386-304-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18674332B00000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies