Provider Demographics
NPI:1871718809
Name:KABAN, LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:KABAN
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 1:32124 PASEO ADELANTO
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3607
Mailing Address - Country:US
Mailing Address - Phone:949-496-5585
Mailing Address - Fax:
Practice Address - Street 1:32124 PASEO ADELANTO
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3607
Practice Address - Country:US
Practice Address - Phone:949-496-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist