Provider Demographics
NPI:1699800920
Name:AMADOR, ANNABELLE
Entity type:Individual
Prefix:DR
First Name:ANNABELLE
Middle Name:
Last Name:AMADOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7236 AMIGO AVE
Mailing Address - Street 2:UNIT 104
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-8108
Mailing Address - Country:US
Mailing Address - Phone:818-300-3538
Mailing Address - Fax:
Practice Address - Street 1:3932 WILSHIRE BLVD
Practice Address - Street 2:UNIT 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3307
Practice Address - Country:US
Practice Address - Phone:213-386-3336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice