Provider Demographics
NPI:1881862977
Name:EBNER, ANTONIA M (RDHAP)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:M
Last Name:EBNER
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:M
Other - Last Name:EBNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:863 I ST STE B
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-4310
Mailing Address - Country:US
Mailing Address - Phone:209-826-5990
Mailing Address - Fax:209-826-6268
Practice Address - Street 1:863 I ST STE B
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-4310
Practice Address - Country:US
Practice Address - Phone:209-826-5990
Practice Address - Fax:209-826-6268
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP3124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYO1864OtherDENTI CAL