MEDICARE: DR. NISRINE CABANI D.M.D

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	1223G0001X	General Practice Dentistry	DN17535	FL

General Provider Information

NPI Number	:	1821202714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NISRINE CABANI D.M.D

Provider Business Mailing Address
First Line	:	535 SEASIDE COVE STREET
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787
Country	:	US
Telephone Number	:	321-948-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2153 E COUNTY ROAD 540A
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3794
Country	:	US
Telephone Number	:	863-709-1903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	03/13/2012

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