Provider Demographics
NPI:1598837130
Name:CHONA M. EBALO-VILLANUEVA DMD INC
Entity Type:Organization
Organization Name:CHONA M. EBALO-VILLANUEVA DMD INC
Other - Org Name:ABEL DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FIDEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:408-946-9696
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty