Provider Demographics
NPI:1275932964
Name:CAFFRONI, EHESAR (DDS,MSD)
Entity Type:Individual
Prefix:
First Name:EHESAR
Middle Name:
Last Name:CAFFRONI
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ISABELLA WAY
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-2197
Mailing Address - Country:US
Mailing Address - Phone:954-854-1195
Mailing Address - Fax:
Practice Address - Street 1:11828 RING DR STE 102
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-2106
Practice Address - Country:US
Practice Address - Phone:512-640-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRP #1173122300000X
TX333461223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1275932964Medicaid