Provider Demographics
NPI:1225112873
Name:CALDWELL, JAY BOYER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:BOYER
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 N MURRAY BLVD STE A
Mailing Address - Street 2:
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 STE A
Practice Address - Street 2:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1056531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice