Provider Demographics
NPI:1891942074
Name:CALDWELL, IAN DESMOND (DMD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:DESMOND
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 WHITE HORSE RD
Mailing Address - Street 2:SUITE 500 - BUILDING E
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2176
Mailing Address - Country:US
Mailing Address - Phone:856-627-3400
Mailing Address - Fax:856-627-3628
Practice Address - Street 1:1307 WHITE HORSE RD
Practice Address - Street 2:SUITE 500 - BUILDING E
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2176
Practice Address - Country:US
Practice Address - Phone:856-627-3400
Practice Address - Fax:856-627-3628
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102379400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist