Provider Demographics
NPI:1336439892
Name:ABRAHAM, REENA (DDS)
Entity Type:Individual
Prefix:
First Name:REENA
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 TALLGRASS LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-2379
Mailing Address - Country:US
Mailing Address - Phone:979-557-3509
Mailing Address - Fax:
Practice Address - Street 1:12250 LAKE JUNE RD
Practice Address - Street 2:#101
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-4716
Practice Address - Country:US
Practice Address - Phone:972-557-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice