Provider Demographics
NPI:1821287814
Name:ABRIOL DENTAL CORP.
Entity Type:Organization
Organization Name:ABRIOL DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICASIO
Authorized Official - Middle Name:MACARAEG
Authorized Official - Last Name:ABRIOL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-259-0458
Mailing Address - Street 1:3068 STORY RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-3934
Mailing Address - Country:US
Mailing Address - Phone:408-259-0458
Mailing Address - Fax:408-729-0559
Practice Address - Street 1:3068 STORY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-3934
Practice Address - Country:US
Practice Address - Phone:408-259-0458
Practice Address - Fax:408-729-0559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB43301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD43301Medicaid