Provider Demographics
NPI:1336277748
Name:ABANTE, VIVENCIO BUNQUIN (DDS)
Entity Type:Individual
Prefix:
First Name:VIVENCIO
Middle Name:BUNQUIN
Last Name:ABANTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 3RD AVE
Mailing Address - Street 2:STE. 120
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1300
Mailing Address - Country:US
Mailing Address - Phone:619-426-1130
Mailing Address - Fax:619-585-8140
Practice Address - Street 1:865 3RD AVE
Practice Address - Street 2:STE. 120
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1300
Practice Address - Country:US
Practice Address - Phone:619-426-1130
Practice Address - Fax:619-585-8140
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA452231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice