Organization
PLATEAU ORAL AND FACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CORTLAND CALDEMEYER DDS (OWNER)
(931) 525-6059
Entity
Organization
Contact information
Practice address
920 S WILLOW AVE, COOKEVILLE, TN 38501-4150
(931) 525-6059
(931) 525-6099
Mailing address
920 S WILLOW AVE, COOKEVILLE, TN 38501-4150
(931) 525-6059
(931) 525-6099
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
9568
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q004187
—
TN
Enumeration date
08/04/2015
Last updated
08/04/2015
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