Provider Demographics
NPI:1831347830
Name:ABIERA, JONATHAN NABONG (DMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:NABONG
Last Name:ABIERA
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 1:780 N MULFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3855
Mailing Address - Country:US
Mailing Address - Phone:815-395-1600
Mailing Address - Fax:
Practice Address - Street 1:780 N MULFORD RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3855
Practice Address - Country:US
Practice Address - Phone:815-395-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist