Basic Information
| Provider Information | |||||||||
| NPI: | 1760569206 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NICHOLAS P CABA DMD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 212 | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970710212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039811841 | ||||||||
| FaxNumber: | 5039817334 | ||||||||
| Practice Location | |||||||||
| Address1: | 1018 N BOONES FERRY RD | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970710212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039811841 | ||||||||
| FaxNumber: | 5039817334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 01/24/2012 | ||||||||
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| AuthorizedOfficialLastName: | CABA | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5039811841 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D6263 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.