Provider Demographics
NPI:1306259007
Name:CABALLEROS, MARCO (DDS)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:
Last Name:CABALLEROS
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 1:1212 N JOSEY LN
Mailing Address - Street 2:#238
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6140
Mailing Address - Country:US
Mailing Address - Phone:972-418-8461
Mailing Address - Fax:972-418-8462
Practice Address - Street 1:1212 N JOSEY LN
Practice Address - Street 2:#238
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6140
Practice Address - Country:US
Practice Address - Phone:972-418-8461
Practice Address - Fax:972-418-8462
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30011122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist