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General NPI Number Information
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NPI Number | 1194851923
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Entity Type | Organization
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Legal Business Name | MILL TOWN DENTAL CLINIC, LLC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 94-428 MOKUOLA ST SUITE 104
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City | WAIPAHU
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State | HI
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Zip | 96797-3396
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Country | US
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Telephone | 808-678-8300
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Fax | 808-678-8303
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Provider Business Mailing Address
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Address Line | 94-428 MOKUOLA ST SUITE 104
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City | WAIPAHU
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State | HI
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Zip | 96797-3396
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Country | US
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Telephone | 808-678-8300
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Fax | 808-678-8303
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MARILOU CABALO CABABAT
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Credential | D.M.D.
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Telephone | 808-678-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DT-1990
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License Number State | HI
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