MEDICARE: JESSICA A CABALLERO DDS

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	122300000X	Dentist	20951	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

General Provider Information

NPI Number	:	1255356010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA A CABALLERO DDS

Provider Business Mailing Address
First Line	:	13231 CHAMPION FOREST DR
Second Line	:	#304
City	:	HOUSTON
State	:	TX
Zip	:	77069-2600
Country	:	US
Telephone Number	:	281-444-2755
Fax Number	:	281-444-6014

Provider Business Practice Location Address
First Line	:	13231 CHAMPION FOREST DR
Second Line	:	#304
City	:	HOUSTON
State	:	TX
Zip	:	77069-2600
Country	:	US
Telephone Number	:	281-444-2755
Fax Number	:	281-444-6014

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	02/01/2011

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Directions to “ JESSICA A CABALLERO DDS” Practice Location

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