Provider Demographics
NPI:1063865384
Name:CARSON B CALDERWOOD DDS PLLC, DBA SNOQUALMIE FALLS DENTAL
Entity Type:Organization
Organization Name:CARSON B CALDERWOOD DDS PLLC, DBA SNOQUALMIE FALLS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARSON
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-831-1790
Mailing Address - Street 1:8026 DOUGLAS AVE SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-6313
Mailing Address - Country:US
Mailing Address - Phone:425-831-1790
Mailing Address - Fax:
Practice Address - Street 1:8026 DOUGLAS AVE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-6313
Practice Address - Country:US
Practice Address - Phone:425-831-1790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA102271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty