Provider Demographics
NPI:1649229949
Name:ABRAHAM, KALIL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KALIL
Middle Name:A
Last Name:ABRAHAM
Suffix:
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 1:23044 CHERRY HILL
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-914-4440
Mailing Address - Fax:313-914-4306
Practice Address - Street 1:23044 CHERRY HILL
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-914-4440
Practice Address - Fax:313-914-4306
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010181951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4535852Medicaid