Provider Demographics
NPI:1407091721
Name:EBALO-VILLANUEVA, CHONA MINAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHONA
Middle Name:MINAS
Last Name:EBALO-VILLANUEVA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 N ABEL ST
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-4833
Mailing Address - Country:US
Mailing Address - Phone:408-946-9696
Mailing Address - Fax:408-946-5381
Practice Address - Street 1:12 N ABEL ST
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-4833
Practice Address - Country:US
Practice Address - Phone:408-946-9696
Practice Address - Fax:408-946-5381
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA038835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist