Provider Demographics
NPI:1124158365
Name:TING, IRENE MALABANAN (DMD)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:MALABANAN
Last Name:TING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 CANARIOS CT
Mailing Address - Street 2:SUITE #212
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7877
Mailing Address - Country:US
Mailing Address - Phone:619-227-8112
Mailing Address - Fax:
Practice Address - Street 1:885 CANARIOS CT
Practice Address - Street 2:SUITE #212
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7877
Practice Address - Country:US
Practice Address - Phone:619-397-7162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist