Provider Demographics
NPI:1326387598
Name:BELENDA VILLARUEL ABANILLA DENTAL CORPORATION
Entity Type:Organization
Organization Name:BELENDA VILLARUEL ABANILLA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BELENDA
Authorized Official - Middle Name:VILLARUEL
Authorized Official - Last Name:ABANILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-584-1171
Mailing Address - Street 1:3017 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5827
Mailing Address - Country:US
Mailing Address - Phone:323-584-1171
Mailing Address - Fax:323-584-0307
Practice Address - Street 1:3017 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5827
Practice Address - Country:US
Practice Address - Phone:323-584-1171
Practice Address - Fax:323-584-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty