Provider Demographics
NPI:1033370374
Name:DR. CALDWELL'S DENTAL OFFICE
Entity Type:Organization
Organization Name:DR. CALDWELL'S DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENITA
Authorized Official - Middle Name:H
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-351-3675
Mailing Address - Street 1:1756 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1819
Mailing Address - Country:US
Mailing Address - Phone:319-351-3675
Mailing Address - Fax:319-351-3675
Practice Address - Street 1:1756 5TH ST
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1819
Practice Address - Country:US
Practice Address - Phone:319-351-3675
Practice Address - Fax:319-351-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7108261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0232058Medicaid
IA232058OtherDELTA DENTAL OF IOWA
IA23205OtherWELLMARK