Provider Demographics
NPI:1033857818
Name:CALDWELL, JORDAN MEREDITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:MEREDITH
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6937 MALLARD XING
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-7810
Mailing Address - Country:US
Mailing Address - Phone:318-450-2941
Mailing Address - Fax:
Practice Address - Street 1:1107 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5503
Practice Address - Country:US
Practice Address - Phone:318-340-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA73031223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice