Provider Demographics
NPI:1528269826
Name:MILAGROSA M. CABANBAN DDS INC
Entity type:Organization
Organization Name:MILAGROSA M. CABANBAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MILAGROSA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:HERNANDEZ-CABANBAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-461-2991
Mailing Address - Street 1:5911 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1309
Mailing Address - Country:US
Mailing Address - Phone:562-461-2991
Mailing Address - Fax:562-461-2981
Practice Address - Street 1:5911 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1309
Practice Address - Country:US
Practice Address - Phone:562-461-2991
Practice Address - Fax:562-461-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty