Provider Demographics
NPI:1033115191
Name:CABRERA, FERNANDO ANTONIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:ANTONIO
Last Name:CABRERA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0400
Mailing Address - Country:US
Mailing Address - Phone:787-798-4848
Mailing Address - Fax:787-798-0454
Practice Address - Street 1:CARRETERA 174 BLOQUE 21#21URB. SANTA ROSA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-798-4848
Practice Address - Fax:787-798-0454
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8301223G0001X
PA232231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice