Provider Demographics
NPI:1417041658
Name:JON E. CABOT DDS MS PC
Entity Type:Organization
Organization Name:JON E. CABOT DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:CABOT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:248-737-2580
Mailing Address - Street 1:7459 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4184
Mailing Address - Country:US
Mailing Address - Phone:248-737-2580
Mailing Address - Fax:248-737-0467
Practice Address - Street 1:7459 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4184
Practice Address - Country:US
Practice Address - Phone:248-737-2580
Practice Address - Fax:248-737-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010131291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty