1366512063 NPI number — DR. KIMBERLY LATONYA CALDWELL D.D.S.

Table of content: DR. KIMBERLY LATONYA CALDWELL D.D.S. (NPI 1366512063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366512063 NPI number — DR. KIMBERLY LATONYA CALDWELL D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALDWELL
Provider First Name:
KIMBERLY
Provider Middle Name:
LATONYA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366512063
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
213 FRENCHMANS BEND PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71203-8932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-327-5976
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2905 STERLINGTON ROAD
Provider Second Line Business Practice Location Address:
CHAUVIN PLAZA
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-322-7717
Provider Business Practice Location Address Fax Number:
318-322-0855
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5438 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1854387 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com