Provider Demographics
NPI:1194851923
Name:MILL TOWN DENTAL CLINIC, LLC
Entity Type:Organization
Organization Name:MILL TOWN DENTAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILOU
Authorized Official - Middle Name:CABALO
Authorized Official - Last Name:CABABAT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-678-8300
Mailing Address - Street 1:94-428 MOKUOLA ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3396
Mailing Address - Country:US
Mailing Address - Phone:808-678-8300
Mailing Address - Fax:808-678-8303
Practice Address - Street 1:94-428 MOKUOLA ST
Practice Address - Street 2:SUITE 104
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3396
Practice Address - Country:US
Practice Address - Phone:808-678-8300
Practice Address - Fax:808-678-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-19901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty