Provider Demographics
NPI:1740457969
Name:CABRERA, RODRIGO JAVIER (DDS)
Entity type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:JAVIER
Last Name:CABRERA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11014 LINDEN GATE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-2440
Mailing Address - Country:US
Mailing Address - Phone:713-899-1789
Mailing Address - Fax:
Practice Address - Street 1:10065 ALMEDA GENOA RD STE J
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-2417
Practice Address - Country:US
Practice Address - Phone:832-308-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1924524-06Medicaid