Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN12284 | FL |
NPI | 1023388790 |
---|---|
Provider Name | Dr. Salvatore Ronald Cabassa |
First Address | Pensacola, FL 32503-2446 |
Second Address | Pensacola, FL 32503-2446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2012 |
Last Update Date | 11/01/2012 |