Provider Demographics
NPI:1619995933
Name:ABRAHAMS, RODNEY RALSTON I (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:RALSTON
Last Name:ABRAHAMS
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-0132
Mailing Address - Country:US
Mailing Address - Phone:276-979-1121
Mailing Address - Fax:276-979-1121
Practice Address - Street 1:204 CAMPBELL LN
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651
Practice Address - Country:US
Practice Address - Phone:276-979-1121
Practice Address - Fax:276-979-1121
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010047491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541050295OtherDELTA METLIFE
VA140394OtherBLUE CROSS BLUE SHIELD
VA176747OtherUNITED CONCORDIA
VA007808411Medicaid