Healthcare Provider Details

I. General information

NPI: 1407968175
Provider Name (Legal Business Name): PHILIP J. CABRERA, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 PARK AVE SUITE 1020
WORCESTER MA
01609-1953
US

IV. Provider business mailing address

130 DARTMOUTH ST #1104
BOSTON MA
02116-5118
US

V. Phone/Fax

Practice location:
  • Phone: 508-792-0295
  • Fax:
Mailing address:
  • Phone: 617-285-1468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number21090
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. PHILIP J CABRERA
Title or Position: ENDODONTIST/OWNER
Credential: DDS
Phone: 508-792-0295