Provider Demographics
NPI:1669691135
Name:GABUTEN, EDUARDO (DMD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:GABUTEN
Suffix:
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 1:22012 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-3307
Mailing Address - Country:US
Mailing Address - Phone:310-834-8963
Mailing Address - Fax:310-834-7312
Practice Address - Street 1:22012 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-3307
Practice Address - Country:US
Practice Address - Phone:310-834-8963
Practice Address - Fax:310-834-7312
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD36539OtherDENTICAL PROVIDER NUMBER