Healthcare Provider Details

I. General information

NPI: 1033857818
Provider Name (Legal Business Name): JORDAN MEREDITH CALDWELL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/23/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 GLENWOOD DR
WEST MONROE LA
71291-5503
US

IV. Provider business mailing address

6937 MALLARD XING
BASTROP LA
71220-7810
US

V. Phone/Fax

Practice location:
  • Phone: 318-340-1003
  • Fax:
Mailing address:
  • Phone: 318-450-2941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7303
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7303
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: