Provider Demographics
NPI:1407909724
Name:CALDEMEYER, CORTLAND S (DDS)
Entity Type:Individual
Prefix:DR
First Name:CORTLAND
Middle Name:S
Last Name:CALDEMEYER
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 1:920 S WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4150
Mailing Address - Country:US
Mailing Address - Phone:931-525-6059
Mailing Address - Fax:931-525-6099
Practice Address - Street 1:920 S WILLOW AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4150
Practice Address - Country:US
Practice Address - Phone:931-525-6059
Practice Address - Fax:931-525-6099
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN82857421223S0112X
CA476931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery