Provider Demographics
NPI:1578967857
Name:CABALLERO, LLC
Entity Type:Organization
Organization Name:CABALLERO, LLC
Other - Org Name:C&C DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIOVANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-865-7622
Mailing Address - Street 1:11211 WAPLES MILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7406
Mailing Address - Country:US
Mailing Address - Phone:703-865-7622
Mailing Address - Fax:703-853-1768
Practice Address - Street 1:11211 WAPLES MILL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7406
Practice Address - Country:US
Practice Address - Phone:703-865-7622
Practice Address - Fax:703-853-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-16
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413094122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty