Provider Demographics
NPI:1316628969
Name:ABRAMSON, PHILLIP DONALD
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:DONALD
Last Name:ABRAMSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 GRAND OVERLOOK ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-4492
Mailing Address - Country:US
Mailing Address - Phone:302-632-2883
Mailing Address - Fax:
Practice Address - Street 1:3208 N ACADEMY BLVD STE 140
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5111
Practice Address - Country:US
Practice Address - Phone:719-301-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00205716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist