MEDICARE: DR. SANDRA I CALDWELL D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7809	MD

General Provider Information

NPI Number	:	1326162256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA I CALDWELL D.D.S

Provider Business Mailing Address
First Line	:	6495 NEW HAMPSHIRE AVE
Second Line	:	SUITE 108
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3245
Country	:	US
Telephone Number	:	301-270-5100
Fax Number	:	301-270-5524

Provider Business Practice Location Address
First Line	:	6495 NEW HAMPSHIRE AVE
Second Line	:	SUITE 108
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3245
Country	:	US
Telephone Number	:	301-270-5100
Fax Number	:	301-270-5524

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	07/08/2007

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