Provider Demographics
NPI:1700068483
Name:ABRAHAM, JAMES G II (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:ABRAHAM
Suffix:II
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 1:4325 JERDON CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-1618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1526 UTE BLVD # 113
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7522
Practice Address - Country:US
Practice Address - Phone:702-218-3605
Practice Address - Fax:702-658-3705
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV22101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice