Provider Demographics
NPI:1427494293
Name:CALDWELL, SUMMER LAUREN (DDS)
Entity type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:LAUREN
Last Name:CALDWELL
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 1:10027 PARK CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8928
Mailing Address - Country:US
Mailing Address - Phone:704-460-6848
Mailing Address - Fax:
Practice Address - Street 1:10027 PARK CEDAR DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8928
Practice Address - Country:US
Practice Address - Phone:704-460-6848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice