Provider Demographics
NPI:1700631538
Name:PANHAM PLLC
Entity Type:Organization
Organization Name:PANHAM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-819-6371
Mailing Address - Street 1:5460 LENA RD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9500
Mailing Address - Country:US
Mailing Address - Phone:941-755-6637
Mailing Address - Fax:
Practice Address - Street 1:1612 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4252
Practice Address - Country:US
Practice Address - Phone:941-758-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PANHAM PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-23
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental