MEDICARE: EMIL ABNER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	101925	CA

General Provider Information

NPI Number	:	1861918831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMIL ABNER DDS

Provider Business Mailing Address
First Line	:	10390 WILSHIRE BLVD APT 717
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-6456
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11955 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5887
Country	:	US
Telephone Number	:	310-237-5747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2017
Last Update Date	:	08/21/2017

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