Provider Demographics
NPI:1386749703
Name:ABRAMS, MELANIE RENEE (DMD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:RENEE
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-2441
Mailing Address - Country:US
Mailing Address - Phone:502-417-9634
Mailing Address - Fax:502-417-9634
Practice Address - Street 1:3438 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-2648
Practice Address - Country:US
Practice Address - Phone:502-366-4442
Practice Address - Fax:502-366-4442
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY83741223G0001X
FLDN176361223G0001X
IN12011421A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100002340Medicaid