=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487593646
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARLOS CABALLERO DDS,MS, PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2026
-----------------------------------------------------
Last Update Date | 03/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1890 POTTERY AVE
-----------------------------------------------------
City | PORT ORCHARD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98366-2510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-895-9099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 NE FAIRGROUNDS RD STE 100
-----------------------------------------------------
City | BREMERTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98311-8629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-692-4811
-----------------------------------------------------
Fax | 360-698-0828
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | CARLOS CABALLERO
-----------------------------------------------------
Credential | DDS,MS,PS
-----------------------------------------------------
Telephone | 360-692-4811
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------