Provider Demographics
NPI:1356059810
Name:CABANES, MERYL CAMILLE TAN (DMD)
Entity type:Individual
Prefix:DR
First Name:MERYL CAMILLE
Middle Name:TAN
Last Name:CABANES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 WHITLEY AVE APT 618
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-4954
Mailing Address - Country:US
Mailing Address - Phone:424-781-2021
Mailing Address - Fax:
Practice Address - Street 1:1850 WHITLEY AVE APT 618
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-4954
Practice Address - Country:US
Practice Address - Phone:424-781-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61254647122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist