Provider Demographics
NPI:1013067560
Name:THOMAS, ABRAHAM KANJAPPALLIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:KANJAPPALLIL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5426 N ACADEMY BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3685
Mailing Address - Country:US
Mailing Address - Phone:719-266-5420
Mailing Address - Fax:719-266-6988
Practice Address - Street 1:5426 N ACADEMY BLVD
Practice Address - Street 2:STE 202
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3685
Practice Address - Country:US
Practice Address - Phone:719-266-5420
Practice Address - Fax:719-266-6988
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO80151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice