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ELAINE ABANTE BERSABA VONG DDS
>> Dentist >> Dental ProvidersRegistrant NPI Number: 1215563622
Individual Registrant: ELAINE ABANTE BERSABA VONG DDS
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
12821 MAIN ST STE 150 HESPERIA, CA 92345-9130 US
Tel: 760-947-9853 Fax: --
Tel: 760-947-9853 Fax: --
Contact information for business:
12481 KOKOMO CT VICTORVILLE, CA 92392-6780 US
Tel: 775-848-1212 Fax: --
Tel: 775-848-1212 Fax: --
Registration Information:
NPI: 1215563622
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 122300000X | Dental Providers Dentist | CA | DDS103724 |
| Y | 1223G0001X | Dental Providers Dentist | CA | DDS103724 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
