Provider Demographics
NPI:1306198619
Name:LOMBANA-CANO, EDWARD HENRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:HENRY
Last Name:LOMBANA-CANO
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 1:2729 MADERIA CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5594
Mailing Address - Country:US
Mailing Address - Phone:321-298-3803
Mailing Address - Fax:
Practice Address - Street 1:1096 CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3328
Practice Address - Country:US
Practice Address - Phone:407-933-8222
Practice Address - Fax:407-933-6964
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL199471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice