Provider Demographics
NPI:1023154457
Name:CABANISS, FRED V (DDS)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:V
Last Name:CABANISS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-2747
Mailing Address - Country:US
Mailing Address - Phone:318-377-9411
Mailing Address - Fax:318-377-1424
Practice Address - Street 1:909 ELM ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-2747
Practice Address - Country:US
Practice Address - Phone:318-377-9411
Practice Address - Fax:318-377-1424
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA32431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice