Provider Demographics
NPI:1508585415
Name:ABJELINA, KYLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:ABJELINA
Suffix:
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 1:253 ROCKY POINT RD
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2621
Mailing Address - Country:US
Mailing Address - Phone:310-684-9020
Mailing Address - Fax:
Practice Address - Street 1:1381 W CHANNEL ISLANDS BLVD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-4203
Practice Address - Country:US
Practice Address - Phone:805-253-1796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107876122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist