Provider Demographics
NPI:1992795926
Name:CALDWELL, GREGORY T (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:T
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BEDFORD ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4320
Mailing Address - Country:US
Mailing Address - Phone:781-861-8855
Mailing Address - Fax:781-861-1994
Practice Address - Street 1:35 BEDFORD ST
Practice Address - Street 2:SUITE 19
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4320
Practice Address - Country:US
Practice Address - Phone:781-861-8855
Practice Address - Fax:781-861-1994
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA199921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANX4900Medicare PIN
MAU91556Medicare UPIN