Provider Demographics
NPI:1538267588
Name:CAPARAS-FERNANDO, JOELY CABALLES (DDS)
Entity type:Individual
Prefix:
First Name:JOELY
Middle Name:CABALLES
Last Name:CAPARAS-FERNANDO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JOELY
Other - Middle Name:CABALLES
Other - Last Name:CAPARAS-FERNANDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:11828 ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-4003
Mailing Address - Country:US
Mailing Address - Phone:562-860-1805
Mailing Address - Fax:562-809-6882
Practice Address - Street 1:11828 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-4003
Practice Address - Country:US
Practice Address - Phone:562-860-1805
Practice Address - Fax:562-809-6882
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice