Provider Demographics
NPI:1720665854
Name:ABRAHAM, JAMIE (DMD, MPH)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MAPLE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-5140
Mailing Address - Country:US
Mailing Address - Phone:413-420-2200
Mailing Address - Fax:413-539-9472
Practice Address - Street 1:230 MAPLE ST STE 1
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5140
Practice Address - Country:US
Practice Address - Phone:413-420-2200
Practice Address - Fax:413-539-9472
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist