Provider Demographics
NPI:1154356806
Name:BRANDON ABBATANGELO, TINA MARIE (DDS/)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:BRANDON ABBATANGELO
Suffix:
Gender:F
Credentials:DDS/
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 S MARYLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89154-9900
Mailing Address - Country:US
Mailing Address - Phone:702-523-4263
Mailing Address - Fax:
Practice Address - Street 1:7389 SILENT WATER WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-1701
Practice Address - Country:US
Practice Address - Phone:702-523-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3322122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist