Provider Demographics
NPI:1790828036
Name:CALDWELL, JOHN LARRY (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LARRY
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:15200 SOUTHWEST FWY
Mailing Address - Street 2:#320
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3845
Mailing Address - Country:US
Mailing Address - Phone:281-565-5437
Mailing Address - Fax:281-565-6448
Practice Address - Street 1:15200 SOUTHWEST FWY
Practice Address - Street 2:#320
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3845
Practice Address - Country:US
Practice Address - Phone:281-565-5437
Practice Address - Fax:281-565-6448
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry