Provider Demographics
NPI:1619655495
Name:CABUGUASON, DIANE MARGRET BALEN (DDS)
Entity Type:Individual
Prefix:
First Name:DIANE MARGRET
Middle Name:BALEN
Last Name:CABUGUASON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5887 CORBIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-3707
Mailing Address - Country:US
Mailing Address - Phone:818-960-9856
Mailing Address - Fax:
Practice Address - Street 1:1135 VITALITY DR STE 130
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4809
Practice Address - Country:US
Practice Address - Phone:702-359-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7847122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist