Provider Demographics
NPI:1932200342
Name:CABUGAO, KRISTIAN ELI (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:ELI
Last Name:CABUGAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10645 TIERRASANTA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2614
Mailing Address - Country:US
Mailing Address - Phone:858-277-6080
Mailing Address - Fax:858-277-4773
Practice Address - Street 1:10645 TIERRASANTA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2614
Practice Address - Country:US
Practice Address - Phone:858-277-6080
Practice Address - Fax:858-277-4773
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice