Provider Demographics
NPI:1427115013
Name:EBBA, MARY ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:EBBA
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 1:836 S GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4806
Mailing Address - Country:US
Mailing Address - Phone:626-852-1711
Mailing Address - Fax:626-852-1713
Practice Address - Street 1:836 S GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4806
Practice Address - Country:US
Practice Address - Phone:626-852-1711
Practice Address - Fax:626-852-1713
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist