Provider Demographics
NPI:1831602796
Name:CALDERON, GWENDOLYN TAYLOR (DDS)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:TAYLOR
Last Name:CALDERON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 OAK GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2428
Mailing Address - Country:US
Mailing Address - Phone:210-459-9907
Mailing Address - Fax:
Practice Address - Street 1:4158 SWANS LNDG
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4239
Practice Address - Country:US
Practice Address - Phone:210-655-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty