Provider Demographics
NPI:1295303527
Name:LEON CABA, ERNESTO ALEJANDRO (DMD)
Entity type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:ALEJANDRO
Last Name:LEON CABA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 S UNIVERSITY DR APT 9105
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1409
Mailing Address - Country:US
Mailing Address - Phone:786-752-1301
Mailing Address - Fax:
Practice Address - Street 1:2900 S UNIVERSITY DR APT 9105
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1409
Practice Address - Country:US
Practice Address - Phone:786-752-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN259731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice