Provider Demographics
NPI:1164713228
Name:CABALLERO DDS, ROUND ROCK, PC
Entity Type:Organization
Organization Name:CABALLERO DDS, ROUND ROCK, PC
Other - Org Name:BRUSH 32 DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:MARIS
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-462-3232
Mailing Address - Street 1:17500 REED PARK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JONESTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78645-4487
Mailing Address - Country:US
Mailing Address - Phone:512-462-3232
Mailing Address - Fax:512-462-3233
Practice Address - Street 1:110 NORTH I-35
Practice Address - Street 2:SUITE 380
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681
Practice Address - Country:US
Practice Address - Phone:512-462-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty