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General NPI Number Information
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NPI Number | 1679587745
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Entity Type | Individual
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Provider Name | PHILLIP ELWOOD CALDWELL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 1367 WALTER REED RD STE 103
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City | FAYETTEVILLE
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State | NC
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Zip | 28304
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Country | US
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Telephone | 910-485-8749
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Fax | 910-485-8398
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Provider Business Mailing Address
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Address Line | 1367 WALTER REED RD STE 103
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4445
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Country | US
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Telephone | 910-485-8749
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Fax | 910-485-8398
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 3774
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License Number State | NC
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