Provider Demographics
NPI:1679129316
Name:CALDWELL, JILLIAN RENEE (DMD)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:RENEE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:JILLIAN
Other - Middle Name:RENEE
Other - Last Name:KERSTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:20713 E. OCOTILLO RD
Mailing Address - Street 2:STE 102
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142
Mailing Address - Country:US
Mailing Address - Phone:480-888-8123
Mailing Address - Fax:480-888-8374
Practice Address - Street 1:20713 E. OCOTILLO RD
Practice Address - Street 2:STE 102
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142
Practice Address - Country:US
Practice Address - Phone:480-888-8123
Practice Address - Fax:480-888-8374
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ104611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice