Healthcare Provider Details

I. General information

NPI: 1326014689
Provider Name (Legal Business Name): ROBERT EDWARD CALDWELL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8232 US HIGHWAY 51 N
MILLINGTON TN
38053-1708
US

IV. Provider business mailing address

8232 HIGHWAY 51 NORTH
MILLINGTON TN
38053-9128
US

V. Phone/Fax

Practice location:
  • Phone: 901-872-7179
  • Fax:
Mailing address:
  • Phone: 901-872-7179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3163
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: