=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174735021
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CABAY FAMILY DENTISTRY, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 08/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 990 AVENUE OF THE CITIES SUITE 1
-----------------------------------------------------
City | EAST MOLINE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61244-4108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-796-1734
-----------------------------------------------------
Fax | 309-796-1730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 990 AVENUE OF THE CITIES SUITE 1
-----------------------------------------------------
City | EAST MOLINE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61244-4108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-796-1734
-----------------------------------------------------
Fax | 309-796-1730
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RONALD JAMES CABAY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 309-796-1734
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 060001636
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------