Provider Demographics
NPI:1588699060
Name:IGNACIO, CLEMENTINE CABADING (DMD)
Entity type:Individual
Prefix:DR
First Name:CLEMENTINE
Middle Name:CABADING
Last Name:IGNACIO
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 1:2415 W LINCOLN AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6490
Mailing Address - Country:US
Mailing Address - Phone:714-220-1032
Mailing Address - Fax:714-220-9032
Practice Address - Street 1:2415 W LINCOLN AVE
Practice Address - Street 2:STE. A
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6490
Practice Address - Country:US
Practice Address - Phone:714-220-1032
Practice Address - Fax:714-220-9032
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB43609-01OtherMEDI-CAL