Provider Demographics
NPI:1780811554
Name:LIENDO, FABIOLA MELISSA (DDS)
Entity type:Individual
Prefix:
First Name:FABIOLA
Middle Name:MELISSA
Last Name:LIENDO
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 1:6100 S PACIFIC COAST HWY APT 23
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5956
Mailing Address - Country:US
Mailing Address - Phone:310-375-7612
Mailing Address - Fax:
Practice Address - Street 1:946 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-2427
Practice Address - Country:US
Practice Address - Phone:310-831-0735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist