Provider Demographics
NPI:1720205792
Name:CALDERWOOD, CARSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARSON
Middle Name:
Last Name:CALDERWOOD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8026 DOUGLAS AVE SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-6313
Mailing Address - Country:US
Mailing Address - Phone:425-831-1790
Mailing Address - Fax:
Practice Address - Street 1:8026 DOUGLAS AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-6313
Practice Address - Country:US
Practice Address - Phone:425-831-1790
Practice Address - Fax:425-449-5942
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE10227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist