Provider Demographics
NPI:1508081985
Name:HIGH PEAKS DENTAL PROFESSIONAL PARTNERSHIP
Entity Type:Organization
Organization Name:HIGH PEAKS DENTAL PROFESSIONAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:CALDON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:518-523-8288
Mailing Address - Street 1:55 BARN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-1051
Mailing Address - Country:US
Mailing Address - Phone:518-523-8288
Mailing Address - Fax:518-523-5986
Practice Address - Street 1:55 BARN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-1050
Practice Address - Country:US
Practice Address - Phone:518-523-8288
Practice Address - Fax:518-523-5986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty