Provider Demographics
NPI:1659038768
Name:CABANA DENTAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:CABANA DENTAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CABANA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-547-6000
Mailing Address - Street 1:1147 STONECREST BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6606
Mailing Address - Country:US
Mailing Address - Phone:803-547-6000
Mailing Address - Fax:803-547-6004
Practice Address - Street 1:1147 STONECREST BLVD STE 105
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-6606
Practice Address - Country:US
Practice Address - Phone:803-547-6000
Practice Address - Fax:803-547-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental