Provider Demographics
NPI:1891852190
Name:CALDWELL, VICTORIA M (DMD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3022
Mailing Address - Country:US
Mailing Address - Phone:856-779-1375
Mailing Address - Fax:
Practice Address - Street 1:108 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3022
Practice Address - Country:US
Practice Address - Phone:856-779-1375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI02039301223P0300X
PADS029454L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics