Provider Demographics
NPI:1508063801
Name:ABADILLA, ERNESTO C JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:C
Last Name:ABADILLA
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73925 HIGHWAY 111 STE A
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4029
Mailing Address - Country:US
Mailing Address - Phone:760-341-0333
Mailing Address - Fax:760-341-0334
Practice Address - Street 1:73925 HIGHWAY 111 STE A
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4029
Practice Address - Country:US
Practice Address - Phone:760-341-0333
Practice Address - Fax:760-341-0334
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice