Healthcare Provider Details

I. General information

NPI: 1639098544
Provider Name (Legal Business Name): MARISSA FRANCES CABRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3276 WEST RD
TRENTON MI
48183-2322
US

IV. Provider business mailing address

17000 YELLOWSTONE DR
NORTHVILLE MI
48168-6834
US

V. Phone/Fax

Practice location:
  • Phone: 734-676-4744
  • Fax:
Mailing address:
  • Phone: 248-513-7391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603199
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: