Healthcare Provider Details

I. General information

NPI: 1215978663
Provider Name (Legal Business Name): STEPHEN F. CALDWELL D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PEABODY ROAD ANX
DERRY NH
03038-1724
US

IV. Provider business mailing address

4 PEABODY ROAD ANX
DERRY NH
03038-1724
US

V. Phone/Fax

Practice location:
  • Phone: 603-434-6433
  • Fax: 603-434-6133
Mailing address:
  • Phone: 603-434-6433
  • Fax: 603-434-6133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1001780
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: