Provider Demographics
NPI:1598992026
Name:CAUDILLO, MARIBEL C (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIBEL
Middle Name:C
Last Name:CAUDILLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIBEL
Other - Middle Name:
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:108 CEDARDALE RD
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2817
Mailing Address - Country:US
Mailing Address - Phone:402-932-3317
Mailing Address - Fax:402-810-9602
Practice Address - Street 1:108 CEDARDALE RD
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2817
Practice Address - Country:US
Practice Address - Phone:402-932-3317
Practice Address - Fax:402-810-9602
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist