Provider Demographics
NPI:1417225228
Name:ALFREDO RODRIGUEZ ABRAMS, DMD, INC.
Entity Type:Organization
Organization Name:ALFREDO RODRIGUEZ ABRAMS, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ ABRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:559-434-9999
Mailing Address - Street 1:9495 N FORT WASHINGTON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-0605
Mailing Address - Country:US
Mailing Address - Phone:559-434-9999
Mailing Address - Fax:
Practice Address - Street 1:9495 N FORT WASHINGTON RD STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-0605
Practice Address - Country:US
Practice Address - Phone:559-434-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462151223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty