Provider Demographics
NPI:1629176102
Name:PABALAN, TERESITA G (DMD)
Entity Type:Individual
Prefix:DR
First Name:TERESITA
Middle Name:G
Last Name:PABALAN
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 1:11818 ROSECRANS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4101
Mailing Address - Country:US
Mailing Address - Phone:562-406-3826
Mailing Address - Fax:562-868-4444
Practice Address - Street 1:11818 ROSECRANS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4101
Practice Address - Country:US
Practice Address - Phone:562-406-3826
Practice Address - Fax:562-868-4444
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36408122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist