Provider Demographics
NPI:1982154027
Name:JOHN B CALDIERARO III, DMD, PC
Entity Type:Organization
Organization Name:JOHN B CALDIERARO III, DMD, PC
Other - Org Name:CALDIERARO DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CALDIERARO
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-635-8333
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190277031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty