Provider Demographics
NPI:1134108111
Name:MABRY, JEFFREY CALDWELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CALDWELL
Last Name:MABRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13510 LANDS END
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-2259
Mailing Address - Country:US
Mailing Address - Phone:210-408-1692
Mailing Address - Fax:210-567-6603
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:MAIL CODE 7888
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-567-0146
Practice Address - Fax:210-567-6603
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX175831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178728503Medicaid
TX178728505Medicaid