Provider Demographics
NPI:1063962942
Name:CHRISTIAN CABELLO PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:CHRISTIAN CABELLO PEDIATRIC DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CABELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-625-5311
Mailing Address - Street 1:6910 MCPHERSON RD
Mailing Address - Street 2:SUITE 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
Practice Address - Street 2:SUITE 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:956-625-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1750571139Medicaid
TX1063962942Medicaid