Basic Information
| Provider Information | |||||||||
| NPI: | 1447400908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALDWELL | ||||||||
| FirstName: | LLENA | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5005 N. PIEDRAS ST | ||||||||
| Address2: | BLDG. 128, USA DENTAL FT BLISS ATTN: CREDENTIALS | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799205001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155685935 | ||||||||
| FaxNumber: | 9155685174 | ||||||||
| Practice Location | |||||||||
| Address1: | 5005 N. PIEDRAS STREET USA DENTAC - FT BLISS | ||||||||
| Address2: | BLDG. 128, USA DENTAC - FT BLISS ATTN: PAMELA LOPEZ | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799205001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155685935 | ||||||||
| FaxNumber: | 9155685174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2008 | ||||||||
| LastUpdateDate: | 08/12/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 24072 | TX | Y | Dental Providers | Dentist |
No ID Information.