Provider Demographics
NPI:1053182758
Name:ADVIENTO, SHERIELAINE EDQUILANG (RDH)
Entity type:Individual
Prefix:MRS
First Name:SHERIELAINE
Middle Name:EDQUILANG
Last Name:ADVIENTO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 CAMINO DEL REY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7052
Mailing Address - Country:US
Mailing Address - Phone:619-884-0858
Mailing Address - Fax:
Practice Address - Street 1:32389 ECHO LN # 10
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92147-5196
Practice Address - Country:US
Practice Address - Phone:619-524-4487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32303124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist