Provider Demographics
NPI:1265683817
Name:CEBALLOS, E. MAURICIO
Entity Type:Individual
Prefix:
First Name:E. MAURICIO
Middle Name:
Last Name:CEBALLOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13750 BRITOAK LN STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2011
Mailing Address - Country:US
Mailing Address - Phone:713-468-8264
Mailing Address - Fax:
Practice Address - Street 1:13750 BRITOAK LN STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2011
Practice Address - Country:US
Practice Address - Phone:713-468-8264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX185181223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics