Provider Demographics
NPI:1588060214
Name:VIVENCIO B. ABANTE, DDS, INC.
Entity type:Organization
Organization Name:VIVENCIO B. ABANTE, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVENCIO
Authorized Official - Middle Name:BUNQUIN
Authorized Official - Last Name:ABANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-426-1130
Mailing Address - Street 1:865 3RD AVE
Mailing Address - Street 2:120
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1300
Mailing Address - Country:US
Mailing Address - Phone:619-426-1130
Mailing Address - Fax:
Practice Address - Street 1:865 3RD AVE
Practice Address - Street 2:120
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1300
Practice Address - Country:US
Practice Address - Phone:619-426-1130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45223261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental