Provider Demographics
NPI:1821124272
Name:ABRAHA, THEODROS ARAYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEODROS
Middle Name:ARAYA
Last Name:ABRAHA
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 1:411 BEASLEY DR APT L3
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2877
Mailing Address - Country:US
Mailing Address - Phone:919-225-1797
Mailing Address - Fax:
Practice Address - Street 1:411 BEASLEY DR APT L3
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2877
Practice Address - Country:US
Practice Address - Phone:919-225-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice