MEDICARE: DR. JEFFREY CALDWELL MABRY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	17583	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134108111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY CALDWELL MABRY D.D.S.

Provider Business Mailing Address
First Line	:	13510 LANDS END
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-2259
Country	:	US
Telephone Number	:	210-408-1692
Fax Number	:	210-567-6603

Provider Business Practice Location Address
First Line	:	7703 FLOYD CURL DR
Second Line	:	MAIL CODE 7888
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3901
Country	:	US
Telephone Number	:	210-567-0146
Fax Number	:	210-567-6603

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	07/18/2011

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Directions to “ DR. JEFFREY CALDWELL MABRY D.D.S.” Practice Location

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