Provider Demographics
NPI:1619655495
Name:CABUGUASON, DIANE MARGRET BALEN (DDS)
Entity type:Individual
Prefix:
First Name:DIANE MARGRET
Middle Name:BALEN
Last Name:CABUGUASON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 N EDWARDS ST APT 931
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-2718
Mailing Address - Country:US
Mailing Address - Phone:818-960-9856
Mailing Address - Fax:
Practice Address - Street 1:4400 N MIDLAND DR STE 702
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3456
Practice Address - Country:US
Practice Address - Phone:432-699-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7847122300000X
TX40749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist