MEDICARE: CABRERA ARELLANO DENTAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1316724677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CABRERA ARELLANO DENTAL CORP

Provider Business Mailing Address
First Line	:	361 RAILROAD CANYON RD STE A
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92532-4455
Country	:	US
Telephone Number	:	951-471-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	361 RAILROAD CANYON RD STE A
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92532-4455
Country	:	US
Telephone Number	:	951-471-1400
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	JORGE CABRERA
Credential	:	DDS
Telephone Number	:	323-408-9709

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	09/11/2023

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