Provider Demographics
NPI:1891082780
Name:AVENIDO, NANNETTE (DDS)
Entity Type:Individual
Prefix:
First Name:NANNETTE
Middle Name:
Last Name:AVENIDO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:NANET
Other - Middle Name:
Other - Last Name:AVENIDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4210 EAGLE ROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-4405
Mailing Address - Country:US
Mailing Address - Phone:323-550-8341
Mailing Address - Fax:
Practice Address - Street 1:4210 EAGLE ROCK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-4405
Practice Address - Country:US
Practice Address - Phone:323-550-8341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist