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General NPI Number Information
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NPI Number | 1326421512
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Entity Type | Individual
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Provider Name | ABIGAIL LUPENA D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 209 RIVERWIND E
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City | PEARL
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State | MS
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Zip | 39208-5653
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Country | US
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Telephone | 601-363-6161
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Fax |
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Provider Business Mailing Address
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Address Line | 322 STILLWATER DR
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City | DAYTON
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State | NV
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Zip | 89403-9029
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Country | US
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Telephone | 775-230-5469
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3848-16
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License Number State | MS
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