=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194487330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABARO DDS CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2021
-----------------------------------------------------
Last Update Date | 10/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4346 SOUTH ST
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90712-1152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-408-3500
-----------------------------------------------------
Fax | 562-408-3736
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4346 SOUTH ST
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90712-1152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-408-3500
-----------------------------------------------------
Fax | 562-408-3736
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGIONAL BILLING MANAGER
-----------------------------------------------------
Name | MS. FAVIOLA SILVA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-835-6839
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------