Provider Demographics
NPI:1730261470
Name:ABRAMS, KELLY (DDS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NEWPORT COURT
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-3040
Mailing Address - Country:US
Mailing Address - Phone:309-263-9606
Mailing Address - Fax:
Practice Address - Street 1:9016 N ALLEN RD
Practice Address - Street 2:SUITE B
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1513
Practice Address - Country:US
Practice Address - Phone:309-690-4500
Practice Address - Fax:309-691-7298
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190223101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice