Individual
STACY CALDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1121 W 2ND ST, BLOOMINGTON, IN 47403-2160
(812) 339-1671
Mailing address
1121 W 2ND ST, BLOOMINGTON, IN 47403-2160
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12013388A
IN
Other
Enumeration date
07/17/2020
Last updated
07/17/2020
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