Provider Demographics
NPI:1528126265
Name:CABALLERO, FERNANDO (DDS)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:CABALLERO
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 1:4046 NE 55TH ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2266
Mailing Address - Country:US
Mailing Address - Phone:206-985-8272
Mailing Address - Fax:
Practice Address - Street 1:19020 BOTHELL WAY NE STE C
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-2996
Practice Address - Country:US
Practice Address - Phone:425-481-5302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA99691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice