Provider Demographics
NPI:1255356010
Name:CABALLERO, JESSICA A (DDS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
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 1:13231 CHAMPION FOREST DR
Mailing Address - Street 2:#304
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-2600
Mailing Address - Country:US
Mailing Address - Phone:281-444-2755
Mailing Address - Fax:281-444-6014
Practice Address - Street 1:13231 CHAMPION FOREST DR
Practice Address - Street 2:#304
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-2600
Practice Address - Country:US
Practice Address - Phone:281-444-2755
Practice Address - Fax:281-444-6014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162961001Medicaid