Provider Demographics
NPI:1194487330
Name:ABARO DDS CORP
Entity Type:Organization
Organization Name:ABARO DDS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FAVIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-835-6839
Mailing Address - Street 1:4346 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1152
Mailing Address - Country:US
Mailing Address - Phone:562-408-3500
Mailing Address - Fax:562-408-3736
Practice Address - Street 1:4346 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1152
Practice Address - Country:US
Practice Address - Phone:562-408-3500
Practice Address - Fax:562-408-3736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306984596Medicaid