Mario Javier Caballero, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DN11572 Issued in FL

Practice address

1389 S. Patrick Drive (Building 1371)
Patrick Air Force Base, FL 32925-3607

Phone

(305) 446-5676

Fax

(305) 446-5265

NPI assigned

Oct 4, 2006

Last updated

Sep 7, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315353600000",
    "number": "1205921004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1389 S. PATRICK DRIVE (BUILDING 1371)",
            "city": "PATRICK AIR FORCE BASE",
            "state": "FL",
            "postal_code": "329253607",
            "telephone_number": "305-446-5676",
            "fax_number": "305-446-5265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1389 S. PATRICK DRIVE (BUILDING 1371)",
            "city": "PATRICK AIR FORCE BASE",
            "state": "FL",
            "postal_code": "329253607",
            "telephone_number": "305-446-5676",
            "fax_number": "305-446-5265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CABALLERO",
        "first_name": "MARIO",
        "middle_name": "JAVIER",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2011-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN11572",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN-11572",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Patrick Air Force Base, FL
• Providers in Patrick Air Force Base, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.