Provider Demographics
NPI:1477175073
Name:ABRAHAM DDS DENTAL CORP
Entity Type:Organization
Organization Name:ABRAHAM DDS DENTAL CORP
Other - Org Name:CARSON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-835-5550
Mailing Address - Street 1:23535 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5522
Mailing Address - Country:US
Mailing Address - Phone:310-835-5550
Mailing Address - Fax:310-834-5550
Practice Address - Street 1:23535 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-5522
Practice Address - Country:US
Practice Address - Phone:310-835-5550
Practice Address - Fax:310-834-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental