Provider Demographics
NPI:1013021575
Name:MICHAEL J. MCCALL D.D.S., PA
Entity Type:Organization
Organization Name:MICHAEL J. MCCALL D.D.S., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-935-2143
Mailing Address - Street 1:306 MAIN STREET
Mailing Address - Street 2:P.O. BOX 458
Mailing Address - City:KAMIAH
Mailing Address - State:ID
Mailing Address - Zip Code:83536
Mailing Address - Country:US
Mailing Address - Phone:208-935-2143
Mailing Address - Fax:
Practice Address - Street 1:306 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KAMIAH
Practice Address - State:ID
Practice Address - Zip Code:83536
Practice Address - Country:US
Practice Address - Phone:208-935-2143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC128433261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental