Provider Demographics
NPI:1336228972
Name:ABRAMS, JEREMY BRIAN (DMD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:BRIAN
Last Name:ABRAMS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:J.
Other - Middle Name:BRIAN
Other - Last Name:ABRAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:942 E NORTH UNION AVE
Mailing Address - Street 2:SUITE A108
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1764
Mailing Address - Country:US
Mailing Address - Phone:801-562-2147
Mailing Address - Fax:801-569-1795
Practice Address - Street 1:942 E NORTH UNION AVE
Practice Address - Street 2:SUITE A108
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1764
Practice Address - Country:US
Practice Address - Phone:801-562-2147
Practice Address - Fax:801-569-1795
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49206931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT49206939901001OtherBLUE CROSS BLUE SHIELD
UT01463896OtherUNITED CONCORDIA