Active NPI
Kalil A Abraham, DDS
- General Practice Dentistry
- Dearborn, MI
National Provider Identifier
1649229949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2901018195
- Practice address
- 23044 Cherry Hill
Dearborn, MI 48124 - Phone
- (313) 914-4440
- Fax
- (313) 914-4306
- NPI assigned
- May 6, 2006
- Last updated
- Dec 10, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2901018195 | MI | Primary |
Addresses
Primary practice location
23044 Cherry Hill
Dearborn, MI 48124
Mailing address
23044 Cherry Hill
Dearborn, MI 48124
Phone (313) 914-4440
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4535852 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901018195 | MI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Executive Dentistry DDS PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dentist
- Dearborn, MI
- NPI 1598007692
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449705600000",
"number": "1649229949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23044 CHERRY HILL",
"city": "DEARBORN",
"state": "MI",
"postal_code": "48124",
"telephone_number": "313-914-4440",
"fax_number": "313-914-4306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23044 CHERRY HILL",
"city": "DEARBORN",
"state": "MI",
"postal_code": "48124",
"telephone_number": "313-914-4440",
"fax_number": "313-914-4306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ABRAHAM",
"first_name": "KALIL",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-06",
"last_updated": "2015-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "2901018195",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4535852",
"state": "MI"
}
],
"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 Dec 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.