Provider Demographics
NPI:1992855498
Name:ABIA, LEA DELLA MARABUT (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEA DELLA
Middle Name:MARABUT
Last Name:ABIA
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 1:7710 FOREST GLENN DRIVE
Mailing Address - Street 2:
Mailing Address - City:KINGS BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:96143
Mailing Address - Country:US
Mailing Address - Phone:530-546-4310
Mailing Address - Fax:530-546-4310
Practice Address - Street 1:8665 SALMON AVE.
Practice Address - Street 2:
Practice Address - City:KINDS BEACH
Practice Address - State:CA
Practice Address - Zip Code:96143
Practice Address - Country:US
Practice Address - Phone:530-546-1970
Practice Address - Fax:530-546-4606
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48073OtherDENTAL STATE LICENSE