Provider Demographics
NPI:1245237197
Name:CABAN GOMEZ, BENIGNO A (MD)
Entity Type:Individual
Prefix:DR
First Name:BENIGNO
Middle Name:A
Last Name:CABAN GOMEZ
Suffix:
Gender:M
Credentials:MD
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 375
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0375
Mailing Address - Country:US
Mailing Address - Phone:787-878-2526
Mailing Address - Fax:787-880-1587
Practice Address - Street 1:AVE. JOSE CEDENO 552
Practice Address - Street 2:ARECIBO MINI PLAZA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-2526
Practice Address - Fax:787-880-1587
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR04911223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health