Provider Demographics
NPI:1821130576
Name:ABRAHAM, MATTHEW S (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:338 KAMOKILA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2055
Mailing Address - Country:US
Mailing Address - Phone:808-674-2255
Mailing Address - Fax:808-674-1771
Practice Address - Street 1:338 KAMOKILA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2055
Practice Address - Country:US
Practice Address - Phone:808-674-2255
Practice Address - Fax:808-674-1771
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY79021223S0112X
HIMD-14911204E00000X
HIDT-23531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery