Basic Information
| Provider Information | |||||||||
| NPI: | 1922728195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASBRATA | ||||||||
| FirstName: | ABIGAIL | ||||||||
| MiddleName: | THERESA | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5508 BUTANO PARK DR | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945383200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106732012 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2465 IRON POINT RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | FOLSOM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956308754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169849600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2022 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 107830 | CA | Y | Dental Providers | Dentist |
No ID Information.