Provider Demographics
NPI:1740388958
Name:CALDWELL, JEFFREY JEROME SR (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JEROME
Last Name:CALDWELL
Suffix:SR
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 1:405 S MCCASKEY RD STE C
Mailing Address - Street 2:P. O. BOX 621
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-2160
Mailing Address - Country:US
Mailing Address - Phone:252-792-1101
Mailing Address - Fax:252-792-1102
Practice Address - Street 1:405 S MCCASKEY RD STE C
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2160
Practice Address - Country:US
Practice Address - Phone:252-792-1101
Practice Address - Fax:252-792-1102
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8991301Medicaid