Healthcare Provider Details

I. General information

NPI: 1992624407
Provider Name (Legal Business Name): CABALLERO DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16990 MAIN ST STE 1
HESPERIA CA
92345-6087
US

IV. Provider business mailing address

16990 MAIN ST STE 1
HESPERIA CA
92345-6087
US

V. Phone/Fax

Practice location:
  • Phone: 760-244-7232
  • Fax: 760-244-5104
Mailing address:
  • Phone: 760-244-7232
  • Fax: 760-244-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JANE CABALLERO
Title or Position: CEO
Credential: DDS
Phone: 310-795-3679