# PARK CEDAR DENTISTRY PARTNERSHIP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Park Cedar Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063415032
- **Authorized official:** DR. SUMMER L CALDWELL DDS (PARTNER)
- **Authorized official phone:** (704) 752-0500

## Contact information

- **Practice address:** 10027 PARK CEDAR DR, STE 100, CHARLOTTE, NC 28210-8903
- **Practice address phone:** (704) 752-0500
- **Practice address fax:** (704) 752-0502
- **Mailing address:** 10027 PARK CEDAR DR, STE 100, CHARLOTTE, NC 28210-8903
- **Mailing address phone:** (704) 752-0500
- **Mailing address fax:** (704) 752-0502

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 9488 | NC | — |
| 1223G0001X | General Practice Dentistry | 7809 | NC | Yes |

## Other

- **Enumeration date:** 05/24/2005
- **Last updated:** 02/10/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 98190 | BLUE CROSS BLUE SHIELD | NC |