Provider Demographics
NPI:1114053477
Name:M SCOTT CALVERT DDS INC
Entity Type:Organization
Organization Name:M SCOTT CALVERT DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-257-6110
Mailing Address - Street 1:10251 TORRE AVE
Mailing Address - Street 2:STE #250
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2184
Mailing Address - Country:US
Mailing Address - Phone:408-257-6110
Mailing Address - Fax:408-257-8469
Practice Address - Street 1:10251 TORRE AVE
Practice Address - Street 2:STE #250
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2184
Practice Address - Country:US
Practice Address - Phone:408-257-6110
Practice Address - Fax:408-257-8469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty