Provider Demographics
NPI:1780009233
Name:ABRI DENTAL CORP
Entity Type:Organization
Organization Name:ABRI DENTAL CORP
Other - Org Name:ABRI DENTAL CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT - CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:747-200-4234
Mailing Address - Street 1:3808 W RIVERSIDE DR
Mailing Address - Street 2:501
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4325
Mailing Address - Country:US
Mailing Address - Phone:818-779-0299
Mailing Address - Fax:888-753-2687
Practice Address - Street 1:3808 W RIVERSIDE DR
Practice Address - Street 2:501
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4325
Practice Address - Country:US
Practice Address - Phone:818-779-0299
Practice Address - Fax:888-753-2687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty