Provider Demographics
NPI:1184845562
Name:LILIBETH L. BABAO, DDS, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:LILIBETH L. BABAO, DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIBETH
Authorized Official - Middle Name:LACANDULA
Authorized Official - Last Name:BABAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-674-8114
Mailing Address - Street 1:73625 HIGHWAY 111 STE E
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4010
Mailing Address - Country:US
Mailing Address - Phone:760-674-8114
Mailing Address - Fax:760-674-8115
Practice Address - Street 1:73625 HIGHWAY 111 STE E
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4010
Practice Address - Country:US
Practice Address - Phone:760-674-8114
Practice Address - Fax:760-674-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty