Provider Demographics
NPI:1093388589
Name:J.CABALLERO D.D.S., INC
Entity Type:Organization
Organization Name:J.CABALLERO D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-795-3679
Mailing Address - Street 1:4220 PHELAN RD
Mailing Address - Street 2:
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92371-3901
Mailing Address - Country:US
Mailing Address - Phone:760-868-2783
Mailing Address - Fax:760-868-5783
Practice Address - Street 1:4220 PHELAN RD
Practice Address - Street 2:
Practice Address - City:PHELAN
Practice Address - State:CA
Practice Address - Zip Code:92371-3901
Practice Address - Country:US
Practice Address - Phone:760-868-2783
Practice Address - Fax:760-868-5783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty