Provider Demographics
NPI:1710131362
Name:ABRAHAM, PAMELA (DMD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E BUCKTHORN ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-3418
Mailing Address - Country:US
Mailing Address - Phone:617-838-7559
Mailing Address - Fax:
Practice Address - Street 1:300 E BUCKTHORN ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3418
Practice Address - Country:US
Practice Address - Phone:617-838-7559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist