Provider Demographics
NPI:1184760860
Name:ABIOG, ANTONIO GUTIERREZ JR (DMD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:GUTIERREZ
Last Name:ABIOG
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 BLOSSOM HILL RD
Mailing Address - Street 2:SUITE W2
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123
Mailing Address - Country:US
Mailing Address - Phone:408-578-6700
Mailing Address - Fax:408-225-0565
Practice Address - Street 1:827 BLOSSOM HILL RD
Practice Address - Street 2:SUITE W2
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123
Practice Address - Country:US
Practice Address - Phone:408-578-6700
Practice Address - Fax:408-225-0565
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist