Provider Demographics
NPI:1225245244
Name:CALDIER, MICHELLE L D
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L D
Last Name:CALDIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-0966
Mailing Address - Country:US
Mailing Address - Phone:206-898-3883
Mailing Address - Fax:
Practice Address - Street 1:4312 HARRIS RD SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5923
Practice Address - Country:US
Practice Address - Phone:206-898-3883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000091321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice