Basic Information
| Provider Information | |||||||||
| NPI: | 1063984656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABHISHEK | ||||||||
| FirstName: | UNKNOWN | ||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | ABHISHEK | ||||||||
| OtherFirstName: | FNU | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11120 STOCKDALE HWY STE 103 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933113680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616650080 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11120 STOCKDALE HWY STE 103 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933113680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616650080 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2018 | ||||||||
| LastUpdateDate: | 12/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DDS103389 | CA | Y | Dental Providers | Dentist |
No ID Information.