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General NPI Number Information
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NPI Number | 1154356806
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Entity Type | Individual
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Provider Name | TINA MARIE BRANDON ABBATANGELO D.D.S/
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Gender | Female
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 7389 SILENT WATER WAY
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City | LAS VEGAS
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State | NV
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Zip | 89149-1701
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Country | US
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Telephone | 702-523-4263
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Fax |
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Provider Business Mailing Address
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Address Line | 4505 S MARYLAND PKWY
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City | LAS VEGAS
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State | NV
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Zip | 89154-9900
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Country | US
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Telephone | 702-523-4263
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3322
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License Number State | NV
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