Provider Demographics
NPI:1306965736
Name:CAYCEDO, CLAUDIO HERMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:CLAUDIO
Middle Name:HERMAN
Last Name:CAYCEDO
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 1:3901 BENETTON WAY
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-5034
Mailing Address - Country:US
Mailing Address - Phone:806-778-8826
Mailing Address - Fax:
Practice Address - Street 1:4215 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2529
Practice Address - Country:US
Practice Address - Phone:254-227-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2385122300000X
TX197061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM912186110OtherDORAL DENTAL - MEDICAID
NM44425864Medicaid
01584804OtherUNITED CONCORDIA