Provider Demographics
NPI:1669848727
Name:CABUGAO DDS INC
Entity Type:Organization
Organization Name:CABUGAO DDS INC
Other - Org Name:ENCORE AT 32 DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CABUGAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MBA
Authorized Official - Phone:707-562-4090
Mailing Address - Street 1:6040 MAIN ST
Mailing Address - Street 2:SUITE 146
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1390
Mailing Address - Country:US
Mailing Address - Phone:707-562-4090
Mailing Address - Fax:707-562-4099
Practice Address - Street 1:6040 MAIN ST
Practice Address - Street 2:SUITE 146
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-1390
Practice Address - Country:US
Practice Address - Phone:707-562-4090
Practice Address - Fax:707-562-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58945261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental