Mina Abraham, DDS
Individual provider Active NPI Dentist · Carson, CA
NPI 1972894673 · NPPES record last updated Mar 14, 2023
Key facts
- NPI
- 1972894673
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 60206 (CA)
- Practice address
- 23535 Avalon Blvd
Carson, CA 90745-5522 - Phone
- (310) 835-5550
- Fax
- (310) 834-5550
- NPI assigned
- Apr 28, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60206 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Abraham DDS Dental Corp | Current |
Accepting new patients | |
| Marquez-Balagtas Dental Corporation | Dentist | Past | Accepting new patients |
Locations
23535 Avalon Blvd
Carson, CA 90745
Phone (310) 835-5550
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 60206 | CA | Yes |
Addresses
Primary practice location
23535 Avalon Blvd
Carson, CA 90745-5522
Mailing address
23535 Avalon Blvd
Carson, CA 90745-5522
Phone (310) 835-5550
Other providers in Carson, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.