Provider Demographics
NPI:1053389403
Name:CALDWELL, ANDRIA P (DDS)
Entity type:Individual
Prefix:
First Name:ANDRIA
Middle Name:P
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 AZALEA PLACE
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426
Mailing Address - Country:US
Mailing Address - Phone:251-809-3925
Mailing Address - Fax:251-809-6058
Practice Address - Street 1:1115 AZALEA PLACE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426
Practice Address - Country:US
Practice Address - Phone:251-809-3925
Practice Address - Fax:251-809-6058
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4357122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL631708021Medicaid
51505815OtherBCBS