Provider Demographics
NPI:1003159476
Name:CALDWELL DENTAL GROUP LTD., LLP
Entity type:Organization
Organization Name:CALDWELL DENTAL GROUP LTD., LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BAXTER
Authorized Official - Last Name:CAMPAGNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:432-694-1659
Mailing Address - Street 1:PO BOX 8307
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79708-8307
Mailing Address - Country:US
Mailing Address - Phone:432-694-1659
Mailing Address - Fax:432-520-0720
Practice Address - Street 1:3722 W LOOP 250 N
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3426
Practice Address - Country:US
Practice Address - Phone:432-694-1659
Practice Address - Fax:432-520-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22092122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty