Provider Demographics
NPI:1639289960
Name:CALDWELL, KEVIN LLOYD (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LLOYD
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-1814
Mailing Address - Country:US
Mailing Address - Phone:417-673-1988
Mailing Address - Fax:417-673-7029
Practice Address - Street 1:624 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-1814
Practice Address - Country:US
Practice Address - Phone:417-673-1988
Practice Address - Fax:417-673-7029
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0140131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice