Provider Demographics
NPI:1033304910
Name:PURITA B EBBAY DMD INC
Entity Type:Organization
Organization Name:PURITA B EBBAY DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PURITA
Authorized Official - Middle Name:BANGASAN
Authorized Official - Last Name:EBBAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-477-1577
Mailing Address - Street 1:1105 E PLAZA BLVD
Mailing Address - Street 2:#C
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950
Mailing Address - Country:US
Mailing Address - Phone:619-477-1577
Mailing Address - Fax:619-477-6014
Practice Address - Street 1:1105 E PLAZA BLVD
Practice Address - Street 2:#C
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-477-1577
Practice Address - Fax:619-477-6014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39789122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty