Healthcare Provider Details

I. General information

NPI: 1447400908
Provider Name (Legal Business Name): DR. LLENA C. CALDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 N. PIEDRAS STREET USA DENTAC - FT BLISS BLDG. 128, USA DENTAC - FT BLISS ATTN: PAMELA LOPEZ
EL PASO TX
79920-5001
US

IV. Provider business mailing address

5005 N. PIEDRAS ST BLDG. 128, USA DENTAL FT BLISS ATTN: CREDENTIALS
EL PASO TX
79920-5001
US

V. Phone/Fax

Practice location:
  • Phone: 915-568-5935
  • Fax: 915-568-5174
Mailing address:
  • Phone: 915-568-5935
  • Fax: 915-568-5174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number24072
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: