Provider Demographics
NPI:1891957130
Name:CALDIERARO, JOHN BATISTA III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BATISTA
Last Name:CALDIERARO
Suffix:III
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 1:20657 STAUNTON RD
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:IL
Mailing Address - Zip Code:62088-4350
Mailing Address - Country:US
Mailing Address - Phone:618-635-8333
Mailing Address - Fax:
Practice Address - Street 1:20657 STAUNTON RD
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:IL
Practice Address - Zip Code:62088-4350
Practice Address - Country:US
Practice Address - Phone:618-635-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027703122300000X
IL019.0277031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist