Provider Demographics
NPI:1063558724
Name:CALDERON-KIDD, JOESOLYN MARCIA (DMD)
Entity type:Individual
Prefix:DR
First Name:JOESOLYN
Middle Name:MARCIA
Last Name:CALDERON-KIDD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5375 S OTIS CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80123-0676
Mailing Address - Country:US
Mailing Address - Phone:303-738-3108
Mailing Address - Fax:303-738-3108
Practice Address - Street 1:3200 S WADSWORTH BLVD UNIT E
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5010
Practice Address - Country:US
Practice Address - Phone:303-716-8546
Practice Address - Fax:303-984-0657
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO75241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice