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General NPI Number Information
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NPI Number | 1033379052
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Entity Type | Organization
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Legal Business Name | JAY B. CALDWELL D.D.S.
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 1711 N MURRAY BLVD STE A
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City | COLORADO SPRINGS
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State | CO
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Zip | 80915-1334
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Country | US
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Telephone | 719-574-3240
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Fax | 719-638-1130
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Provider Business Mailing Address
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Address Line | 1711 N MURRAY BLVD STE A
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City | COLORADO SPRINGS
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State | CO
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Zip | 80915-1334
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Country | US
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Telephone | 719-574-3240
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Fax | 719-638-1130
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY B. CALDWELL
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Credential | DDS
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Telephone | 719-574-3240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 105653
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License Number State | CO
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