Provider Demographics
NPI:1750571139
Name:CABELLO, CHRISTIAN C (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:C
Last Name:CABELLO
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 1:6910 MCPHERSON RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6407
Mailing Address - Country:US
Mailing Address - Phone:956-625-5311
Mailing Address - Fax:956-625-5333
Practice Address - Street 1:6910 MCPHERSON RD STE 2
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6407
Practice Address - Country:US
Practice Address - Phone:956-625-5311
Practice Address - Fax:956-625-5311
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23479122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23479OtherTEXAS STATE LICENSE
TX23479OtherTEXAS STATE LICENSE
TX8K3563Medicare PIN