MEDICARE: JON W CALDWELL, DMD, PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1962340075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JON W CALDWELL, DMD, PLLC

Provider Business Mailing Address
First Line	:	115 PELLY AVE N
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-5714
Country	:	US
Telephone Number	:	425-226-3192
Fax Number	:	425-226-9848

Provider Business Practice Location Address
First Line	:	115 PELLY AVE N
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-5714
Country	:	US
Telephone Number	:	425-226-3192
Fax Number	:	425-226-9848

Authorized Official
Title or Position	:	OWNER
Name	:	JON CALDWELL
Credential	:	DMD
Telephone Number	:	206-399-1166

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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