MEDICARE: CASSANDRA ESCOBEDO

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	41260	TX

General Provider Information

NPI Number	:	1477304533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA ESCOBEDO

Provider Business Mailing Address
First Line	:	7925 S BROADWAY AVE STE 300
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-5247
Country	:	US
Telephone Number	:	903-561-2232
Fax Number	:	903-561-2228

Provider Business Practice Location Address
First Line	:	7925 S BROADWAY AVE STE 300
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-5247
Country	:	US
Telephone Number	:	903-561-2232
Fax Number	:

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

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	02/02/2026

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Directions to “ CASSANDRA ESCOBEDO ” Practice Location

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