Individual
DR. LEONARD BRUCE KABAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD MD
Contact information
Practice address
15 PARKMAN ST, WAC 230 ORAL AND MAXILLOFACIAL SURGERY, BOSTON, MA 02114-3117
(617) 726-8222
(617) 726-2814
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
36801
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2022931
—
MA
01
—
700142
TUFTS HEALTH PLAN
MA
01
—
M08668
BCBS MA
MA
Enumeration date
11/03/2005
Last updated
07/08/2007
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