NPIMap

Organization Active NPI

Executive Dentistry DDS PC

  • Dentist
  • Dearborn, MI
National Provider Identifier
1598007692
Registry record updated Mar 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
18195 Issued in MI
Legal business name
EXECUTIVE DENTISTRY DDS PC
Practice address
23044 Cherry Hill St
Dearborn, MI 48124-1066
Phone
(313) 914-4440
NPI assigned
Mar 27, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2017

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

Authorized official

Name
Dr. Kalil A Abraham, DDS, FAGD, FKOLNPI 1649229949
Title
Owner
Phone
(313) 914-4440

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 18195 MI Primary

Addresses

Primary practice location

23044 Cherry Hill St
Dearborn, MI 48124-1066

Mailing address

23044 Cherry Hill St
Dearborn, MI 48124-1066
Phone (313) 914-4440

National Provider Directory

National Provider Directory

Locations

23044 Cherry Hill St
Dearborn, MI 48124
Phone (313) 914-4440

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1364342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489017600000",
    "number": "1598007692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23044 CHERRY HILL ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241066",
            "telephone_number": "313-914-4440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23044 CHERRY HILL ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241066",
            "telephone_number": "313-914-4440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE DENTISTRY DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-27",
        "last_updated": "2017-03-09",
        "status": "A",
        "authorized_official_last_name": "ABRAHAM",
        "authorized_official_first_name": "KALIL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-914-4440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, FAGD, FKOL"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "18195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.