Individual
KELSEY CALDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5175 NE MARTIN LUTHER KING JR BLVD STE 110, PORTLAND, OR 97211-3233
(503) 406-1108
Mailing address
17419 SW CRICKET CT, BEAVERTON, OR 97003-4569
(503) 922-9565
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D12005
OR
Other
Enumeration date
05/08/2023
Last updated
07/25/2024
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