Provider Demographics
NPI:1245648229
Name:ABRAHAO, THALIA MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:THALIA
Middle Name:MARIE
Last Name:ABRAHAO
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 1:25 WOODPORT RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2408
Mailing Address - Country:US
Mailing Address - Phone:973-729-9044
Mailing Address - Fax:973-729-5666
Practice Address - Street 1:25 WOODPORT RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2408
Practice Address - Country:US
Practice Address - Phone:973-729-9044
Practice Address - Fax:973-729-5666
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025800001223G0001X
FLDN207641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice