Provider Demographics
NPI:1528689148
Name:ABUDE DENTAL CORPORATION
Entity type:Organization
Organization Name:ABUDE DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-936-0250
Mailing Address - Street 1:28895 GREENSPOT RD # 103
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5770
Mailing Address - Country:US
Mailing Address - Phone:909-280-5342
Mailing Address - Fax:909-566-0138
Practice Address - Street 1:28895 GREENSPOT RD # 103
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5770
Practice Address - Country:US
Practice Address - Phone:909-280-5342
Practice Address - Fax:909-566-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497196117OtherNP1 1