Provider Demographics
NPI:1023255163
Name:ABRAHAM, CECIL (DDS)
Entity type:Individual
Prefix:DR
First Name:CECIL
Middle Name:
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 1:6705 RED ROAD
Mailing Address - Street 2:SUITE 614
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3649
Mailing Address - Country:US
Mailing Address - Phone:305-668-1811
Mailing Address - Fax:305-668-1807
Practice Address - Street 1:6705 RED ROAD
Practice Address - Street 2:SUITE 614
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-3649
Practice Address - Country:US
Practice Address - Phone:305-668-1811
Practice Address - Fax:305-668-1807
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL99621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice