Provider Demographics
NPI:1225254329
Name:CALDWELL, DAVID J (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E PINEVIEW DR.
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232
Mailing Address - Country:US
Mailing Address - Phone:601-992-1285
Mailing Address - Fax:601-992-6526
Practice Address - Street 1:102 E PINEVIEW DR.
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232
Practice Address - Country:US
Practice Address - Phone:601-992-1285
Practice Address - Fax:601-992-6526
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2464-89122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09483011Medicaid