MEDICARE: MILAGROSA M. CABANBAN DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	39965	CA

General Provider Information

NPI Number	:	1528269826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILAGROSA M. CABANBAN DDS INC

Provider Business Mailing Address
First Line	:	5911 SOUTH ST
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-1309
Country	:	US
Telephone Number	:	562-461-2991
Fax Number	:	562-461-2981

Provider Business Practice Location Address
First Line	:	5911 SOUTH ST
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-1309
Country	:	US
Telephone Number	:	562-461-2991
Fax Number	:	562-461-2981

Authorized Official
Title or Position	:	CEO
Name	:	DR. MILAGROSA MARIA HERNANDEZ-CABANBAN
Credential	:	DDS
Telephone Number	:	562-461-2991

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	06/15/2012

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