Provider Demographics
NPI:1033379052
Name:JAY B. CALDWELL D.D.S.
Entity Type:Organization
Organization Name:JAY B. CALDWELL D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:B
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-574-3240
Mailing Address - Street 1:1711 N MURRAY BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-1334
Mailing Address - Country:US
Mailing Address - Phone:719-574-3240
Mailing Address - Fax:719-638-1130
Practice Address - Street 1:1711 N MURRAY BLVD
Practice Address - Street 2:STE A
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-1334
Practice Address - Country:US
Practice Address - Phone:719-574-3240
Practice Address - Fax:719-638-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105653261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental