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General NPI Number Information
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NPI Number | 1881906634
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Entity Type | Individual
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Provider Name | CRATISA LATWANN CALDWELL DDS
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Gender | Female
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 08/10/2018
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Provider Practice Location Address
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Address Line | 8151 E 21ST ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46219
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Country | US
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Telephone | 317-353-8505
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Fax |
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Provider Business Mailing Address
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Address Line | 3952 N PARK AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-2714
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Country | US
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Telephone | 317-956-0551
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Fax |
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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 | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 6088
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12011470A
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License Number State | IN
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