Provider Demographics
NPI:1720144678
Name:ABRAMS, MARC BRUCE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:BRUCE
Last Name:ABRAMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 249
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6831
Mailing Address - Country:US
Mailing Address - Phone:314-569-2201
Mailing Address - Fax:314-569-2320
Practice Address - Street 1:456 N NEW BALLAS RD
Practice Address - Street 2:SUITE 249
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6831
Practice Address - Country:US
Practice Address - Phone:314-569-2201
Practice Address - Fax:314-569-2320
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO111519OtherCIGNA HMO
MO29075OtherBCBS
MOT80996OtherMEDICARE ID- TYPE UNSPECIFIED DR ABRAMS