Provider Demographics
NPI:1013922459
Name:TABERNA, MILAGROS LINGAT (DMD)
Entity Type:Individual
Prefix:DR
First Name:MILAGROS
Middle Name:LINGAT
Last Name:TABERNA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MILA
Other - Middle Name:LINGAT
Other - Last Name:TABERNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:282 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5315
Mailing Address - Country:US
Mailing Address - Phone:408-946-4815
Mailing Address - Fax:408-946-3249
Practice Address - Street 1:282 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5315
Practice Address - Country:US
Practice Address - Phone:408-946-4815
Practice Address - Fax:408-946-3249
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B4250001OtherDENTI CAL