Provider Demographics
NPI:1730355470
Name:PRETORIUS, ABRAHAM MARTHINUS (DMD)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:MARTHINUS
Last Name:PRETORIUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5021
Mailing Address - Country:US
Mailing Address - Phone:617-328-3636
Mailing Address - Fax:617-376-0980
Practice Address - Street 1:10 GRANITE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5021
Practice Address - Country:US
Practice Address - Phone:617-328-3636
Practice Address - Fax:617-376-0980
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA173581223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics