MEDICARE: GWENDOLYN TAYLOR CALDERON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	33106	TX

General Provider Information

NPI Number	:	1831602796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN TAYLOR CALDERON DDS

Provider Business Mailing Address
First Line	:	327 OAK GLEN DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-2428
Country	:	US
Telephone Number	:	210-459-9907
Fax Number	:

Provider Business Practice Location Address
First Line	:	4158 SWANS LNDG
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-4239
Country	:	US
Telephone Number	:	210-655-4867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2017
Last Update Date	:	10/21/2024

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