Provider Demographics
NPI:1164518890
Name:CABRERA, TONY T (DDS)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:T
Last Name:CABRERA
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 1:12540 10TH ST
Mailing Address - Street 2:A
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3503
Mailing Address - Country:US
Mailing Address - Phone:909-627-0921
Mailing Address - Fax:909-628-5857
Practice Address - Street 1:12540 10TH ST
Practice Address - Street 2:A
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3503
Practice Address - Country:US
Practice Address - Phone:909-627-0921
Practice Address - Fax:909-628-5857
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA842662OtherUNITED CONCORDIA