Healthcare Provider Details

I. General information

NPI: 1790868461
Provider Name (Legal Business Name): DAVID E CABECEIRAS DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 TUCKER STREET
FALL RIVER MA
02721
US

IV. Provider business mailing address

456 TUCKER STREET
FALL RIVER MA
02721
US

V. Phone/Fax

Practice location:
  • Phone: 508-678-0564
  • Fax: 508-679-2315
Mailing address:
  • Phone: 508-678-0564
  • Fax: 508-679-2315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number15619
License Number StateMA

VIII. Authorized Official

Name: DR. DAVID ELIAS CABECEIRAS
Title or Position: PRESIDENT
Credential: DMD
Phone: 508-678-0564