Provider Demographics
NPI:1629068820
Name:CABRERA, PHILIP J (DDS, FRCD (C))
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:CABRERA
Suffix:
Gender:M
Credentials:DDS, FRCD (C)
Other - Prefix:
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Mailing Address - Street 1:255 PARK AVE
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1953
Mailing Address - Country:US
Mailing Address - Phone:508-792-4290
Mailing Address - Fax:508-792-0295
Practice Address - Street 1:255 PARK AVE
Practice Address - Street 2:SUITE 1020
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1953
Practice Address - Country:US
Practice Address - Phone:508-792-4290
Practice Address - Fax:508-792-0295
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA200031223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA20003OtherSTATE LICENSE NUMBER
MA11-12-0000Medicaid