Provider Demographics
NPI:1962584029
Name:CALDWELL, DAVID M (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
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 1:2955 HARRISON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1155
Mailing Address - Country:US
Mailing Address - Phone:409-923-1602
Mailing Address - Fax:409-923-1603
Practice Address - Street 1:2955 HARRISON ST STE 103
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1155
Practice Address - Country:US
Practice Address - Phone:409-923-1602
Practice Address - Fax:409-923-1603
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111308603Medicaid