Healthcare Provider Details

I. General information

NPI: 1528126265
Provider Name (Legal Business Name): FERNANDO CABALLERO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 NE 195TH ST STE 104
BOTHELL WA
98011-5769
US

IV. Provider business mailing address

11511 NE 195TH ST STE 104
BOTHELL WA
98011-5769
US

V. Phone/Fax

Practice location:
  • Phone: 425-481-5302
  • Fax:
Mailing address:
  • Phone: 425-481-5302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9969
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: