Provider Demographics
NPI:1588767354
Name:CALDWELL, JOHN DAVID (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 KIRBY WHITTEN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134
Mailing Address - Country:US
Mailing Address - Phone:901-388-9883
Mailing Address - Fax:901-384-9353
Practice Address - Street 1:3105 KIRBY WHITTEN PARKWAY
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134
Practice Address - Country:US
Practice Address - Phone:901-388-9883
Practice Address - Fax:901-384-9353
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS34581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3087388OtherBLUE CROSS