Provider Demographics
NPI:1508064676
Name:CABALLERO, EVELYN ORTEGA (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:ORTEGA
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11373 W FLAGLER ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-4203
Mailing Address - Country:US
Mailing Address - Phone:305-554-4304
Mailing Address - Fax:305-554-4326
Practice Address - Street 1:11373 W FLAGLER ST
Practice Address - Street 2:SUITE 214
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4203
Practice Address - Country:US
Practice Address - Phone:305-554-4304
Practice Address - Fax:305-554-4326
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00133011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice