Provider Demographics
NPI:1366423162
Name:KABAN, GERALD PHILLIP (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:PHILLIP
Last Name:KABAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ALAMO DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687
Mailing Address - Country:US
Mailing Address - Phone:707-689-5075
Mailing Address - Fax:
Practice Address - Street 1:3000 ALAMO DR
Practice Address - Street 2:SUITE 109
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6350
Practice Address - Country:US
Practice Address - Phone:707-689-5075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA033940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist