Provider Demographics
NPI:1861857104
Name:OVERSEAS DENTAL
Entity Type:Organization
Organization Name:OVERSEAS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:CABANZON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-301-6991
Mailing Address - Street 1:103400 OVERSEAS HWY #234
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2849
Mailing Address - Country:US
Mailing Address - Phone:305-453-9015
Mailing Address - Fax:
Practice Address - Street 1:103400 OVERSEAS HWY STE 234
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2849
Practice Address - Country:US
Practice Address - Phone:305-453-9105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty