Provider Demographics
NPI:1598950669
Name:CALDON, NATHANIEL BOONE (DMD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:BOONE
Last Name:CALDON
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 1:4429 MONTE CARLO DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4868
Mailing Address - Country:US
Mailing Address - Phone:518-330-9597
Mailing Address - Fax:
Practice Address - Street 1:606 FISHER ST
Practice Address - Street 2:SUITE E
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39534-2513
Practice Address - Country:US
Practice Address - Phone:228-376-0511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist