Charles G Abraham, DDS
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · Indianapolis, IN
NPI 1003336249 · NPPES record last updated Jul 3, 2018
Key facts
- NPI
- 1003336249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- License
- LDR180202 (IN)
- Practice address
- 550 University Blvd # Uh3195
Indianapolis, IN 46202 - Phone
- (317) 274-8300
- Fax
- (317) 274-8300
- NPI assigned
- Jun 20, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 1, 2023 through Nov 1, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09397 | IA | MD | General Practice Dentistry |
Practice roles (2 of 5)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bloomington Oral Surgery | Oral and Maxillofacial Surgery | Past | Accepting new patients |
| Indiana University | General Practice | Past | Accepting new patients |
Networks
- IL HMO C-SNP
- KY PPO C-SNP
- devoted network organization-598bd2d4-c652-473f-ba7a-132f674c8eb6
Interoperability endpoints
- cabraham4@direct.iuhealth.org
- https://api.platform.athenahealth.com/8479/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 09397 | IA | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | LDR180202 | IN | Yes |
Addresses
Primary practice location
550 University Blvd # Uh3195
Indianapolis, IN 46202
Mailing address
322 Dental Science BLDG S
Iowa City, IA 52242-1001
Phone (319) 335-7440
Other providers in Indianapolis, IN
- Abounding Joy Counseling & Wellness Services
- Above & Beyond Homecare Services
- Above and Beyond Services Inc.
- Steven Abragan
- Bindu C Abraham
- Olivia Carter Abraham
- Tanya Mary Abraham
- Vinu Simon Abraham
- Melanie Abrahams
- Abram Sinn Ma MFT LLC
All providers in Indianapolis, IN · Oral and Maxillofacial Surgery (Dentist) in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.