Provider Demographics
NPI:1063541738
Name:CALDWELL, KENNETH LLOYD (DMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:LLOYD
Last Name:CALDWELL
Suffix:
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 1:69 N WREN DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1247
Mailing Address - Country:US
Mailing Address - Phone:412-276-8858
Mailing Address - Fax:
Practice Address - Street 1:69 N WREN DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1247
Practice Address - Country:US
Practice Address - Phone:412-276-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO19976L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice