Healthcare Provider Details

I. General information

NPI: 1578575429
Provider Name (Legal Business Name): JOHN FRANKLIN CAUDILL, II D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG N46, CAPE SARICHEF
KODIAK AK
99619-5002
US

IV. Provider business mailing address

920 E REZANOF DR
KODIAK AK
99615-6724
US

V. Phone/Fax

Practice location:
  • Phone: 907-487-5757
  • Fax: 907-487-5360
Mailing address:
  • Phone: 907-487-5757
  • Fax: 907-487-5360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401005875
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401005875
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: