1497196117 NPI number — DR. PETER ABUDE D.D.S

Table of content: DR. PETER ABUDE D.D.S (NPI 1497196117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497196117 NPI number — DR. PETER ABUDE D.D.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABUDE
Provider First Name:
PETER
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABUDE
Provider Other First Name:
PETER
Provider Other Middle Name:
OBIAJURU
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1497196117
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28895 GREENSPOT RD UNIT 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92346-5770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-280-5342
Provider Business Mailing Address Fax Number:
909-566-0138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28895 GREENSPOT RD UNIT 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92346-5770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-280-5342
Provider Business Practice Location Address Fax Number:
909-566-0138
Provider Enumeration Date:
07/10/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  62541 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)