Provider Demographics
NPI:1174735021
Name:CABAY FAMILY DENTISTRY, LTD.
Entity type:Organization
Organization Name:CABAY FAMILY DENTISTRY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CABAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:309-796-1734
Mailing Address - Street 1:990 AVENUE OF THE CITIES
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-4108
Mailing Address - Country:US
Mailing Address - Phone:309-796-1734
Mailing Address - Fax:309-796-1730
Practice Address - Street 1:990 AVENUE OF THE CITIES
Practice Address - Street 2:SUITE 1
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4108
Practice Address - Country:US
Practice Address - Phone:309-796-1734
Practice Address - Fax:309-796-1730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0600016361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty