Provider Demographics
NPI:1619143062
Name:CABANA, DONALD WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WILLIAM
Last Name:CABANA
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 1:1147 STONECREST BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6555
Mailing Address - Country:US
Mailing Address - Phone:803-547-6000
Mailing Address - Fax:
Practice Address - Street 1:1147 STONECREST BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-6555
Practice Address - Country:US
Practice Address - Phone:803-547-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice