Provider Demographics
NPI:1609039452
Name:KAREN AVANTINO DDS PRO CORP
Entity Type:Organization
Organization Name:KAREN AVANTINO DDS PRO CORP
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:AVANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-222-6939
Mailing Address - Street 1:2421 HARTNELL AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2340
Mailing Address - Country:US
Mailing Address - Phone:530-222-6939
Mailing Address - Fax:
Practice Address - Street 1:2421 HARTNELL
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002
Practice Address - Country:US
Practice Address - Phone:530-222-6939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01OtherDENTIST
CA01OtherDENTIST