Provider Demographics
NPI:1093902504
Name:PHILIP J. CABRERA, D.D.S., F.R.C.D. (C), P.C.
Entity Type:Organization
Organization Name:PHILIP J. CABRERA, D.D.S., F.R.C.D. (C), P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, FRCD (C)
Authorized Official - Phone:508-792-4290
Mailing Address - Street 1:255 PARK AVE
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1953
Mailing Address - Country:US
Mailing Address - Phone:508-792-4290
Mailing Address - Fax:508-792-0295
Practice Address - Street 1:255 PARK AVE
Practice Address - Street 2:SUITE 1020
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1953
Practice Address - Country:US
Practice Address - Phone:508-792-4290
Practice Address - Fax:508-792-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200031223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty