Healthcare Provider Details

I. General information

NPI: 1922167998
Provider Name (Legal Business Name): MARK D CABANA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 MAIN ST SUITE 315
DOWNERS GROVE IL
60516
US

IV. Provider business mailing address

8125 HESS AVE
LA GRANGE IL
60525
US

V. Phone/Fax

Practice location:
  • Phone: 630-969-5350
  • Fax: 630-969-4692
Mailing address:
  • Phone: 708-783-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: