Provider Demographics
NPI:1396403820
Name:CALDERA DENTAL GROUP
Entity Type:Organization
Organization Name:CALDERA DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PRIMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-604-2900
Mailing Address - Street 1:2727 SW 17TH PL
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1297
Mailing Address - Country:US
Mailing Address - Phone:541-604-2900
Mailing Address - Fax:
Practice Address - Street 1:2727 SW 17TH PL
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1297
Practice Address - Country:US
Practice Address - Phone:360-921-4735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental