Provider Demographics
NPI:1700472602
Name:ABRAHAMS, BENJAMIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:ABRAHAMS
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 1:5230 BOULDER HWY STE 130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-6079
Mailing Address - Country:US
Mailing Address - Phone:702-851-6724
Mailing Address - Fax:
Practice Address - Street 1:5230 BOULDER HWY STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6079
Practice Address - Country:US
Practice Address - Phone:702-851-6724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7424122300000X, 1223E0200X, 1223G0001X, 1223P0300X, 1223P0700X, 1223S0112X, 1223X0400X, 1223X2210X, 122400000X
NV7424TU122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
No1223P0300XDental ProvidersDentistPeriodontics
No1223P0700XDental ProvidersDentistProsthodontics
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223X2210XDental ProvidersDentistOrofacial Pain
No122400000XDental ProvidersDenturist