Provider Demographics
NPI:1740519024
Name:ABTIN, DILSHAD (DDS)
Entity type:Individual
Prefix:DR
First Name:DILSHAD
Middle Name:
Last Name:ABTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3271 MALCOLM AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4408
Mailing Address - Country:US
Mailing Address - Phone:818-521-5120
Mailing Address - Fax:
Practice Address - Street 1:180 E MISSION BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1843
Practice Address - Country:US
Practice Address - Phone:909-623-5278
Practice Address - Fax:909-623-5270
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA588221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice