# JONATHAN R ABRAHAM, DDS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316330210
- **Authorized official:** DR. JONATHAN ROBERT ABRAHAM DDS (OWNER DENTIST)
- **Authorized official phone:** (304) 925-0322

## Contact information

- **Practice address:** 3814 MACCORKLE AVE SE, CHARLESTON, WV 25304-1528
- **Practice address phone:** (304) 925-0322
- **Practice address fax:** (304) 925-2337
- **Mailing address:** 3814 MACCORKLE AVE SE, CHARLESTON, WV 25304-1528
- **Mailing address phone:** (304) 925-0322
- **Mailing address fax:** (304) 925-2337

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 3622 | WV | Yes |

## Other

- **Enumeration date:** 03/17/2015
- **Last updated:** 03/17/2015