Provider Demographics
NPI:1750666251
Name:CALDWELL, GREGORY RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:RYAN
Last Name:CALDWELL
Suffix:
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 1:10312 COUNTRY SWAN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4405
Mailing Address - Country:US
Mailing Address - Phone:915-227-6402
Mailing Address - Fax:
Practice Address - Street 1:7703 FLOYD CURL DRIVE
Practice Address - Street 2:MSC 7894 / UTHSCSA / DEPARTMENT OF PERIODONTICS
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3900
Practice Address - Country:US
Practice Address - Phone:210-567-3589
Practice Address - Fax:210-567-3761
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist