Individual provider Active NPI

Michael Alexander Abraham, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Bradenton, FL
National Provider Identifier
1104188937
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DN19695 Issued in FL
Practice address
5460 Lena Rd Unit 102
Bradenton, FL 34211-9500
Phone
(941) 755-6637
NPI assigned
Jun 7, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DN19695 FL Primary

Addresses

Primary practice location

5460 Lena Rd Unit 102
Bradenton, FL 34211-9500

Mailing address

5460 Lena Rd Unit 102
Bradenton, FL 34211-9500
Phone (941) 755-6637

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160830001704 FL Order and Referring Only - DentistPractitioner - Dentist 1951696939

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Panham PLLC CurrentSince Apr 28, 2024 Accepting new patients
University of Frida Dentist Past Accepting new patients
Manatee Oral and Facial Surgery Center LLC Oral and Maxillofacial Surgery PastSince Apr 28, 2024 Accepting new patients

Locations

5460 Lena Rd
Unit 102
Bradenton, FL 34211
Phone (502) 644-7833

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1104188937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5460 LENA RD UNIT 102",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342119500",
            "telephone_number": "941-755-6637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5460 LENA RD UNIT 102",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342119500",
            "telephone_number": "941-755-6637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABRAHAM",
        "first_name": "MICHAEL",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-07",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN19695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.