Provider Demographics
NPI:1255650115
Name:CALDWELL CROSSINGS DENTISTRY
Entity Type:Organization
Organization Name:CALDWELL CROSSINGS DENTISTRY
Other - Org Name:LEE & MELAZZO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MELAZZO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-991-5343
Mailing Address - Street 1:4516 VALLEYDALE ROAD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242
Mailing Address - Country:US
Mailing Address - Phone:205-991-5343
Mailing Address - Fax:205-991-7548
Practice Address - Street 1:4516 VALLEYDALE ROAD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242
Practice Address - Country:US
Practice Address - Phone:205-991-5343
Practice Address - Fax:205-991-7548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental