Provider Demographics
NPI:1982724365
Name:ABRAMOVITCH, KENNETH (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:ABRAMOVITCH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6516 M. D. ANDERSON BLVD.
Mailing Address - Street 2:SUITE 1.072C
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3402
Mailing Address - Country:US
Mailing Address - Phone:713-500-4109
Mailing Address - Fax:713-500-0412
Practice Address - Street 1:6516 MD ANDERSON BLVD
Practice Address - Street 2:SUITE 1.072C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3402
Practice Address - Country:US
Practice Address - Phone:713-500-4109
Practice Address - Fax:713-500-0412
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159561223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV01621Medicare UPIN
610973Medicare ID - Type Unspecified