Provider Demographics
NPI:1124014154
Name:KALANGE, JOHN T (DDS, MS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:KALANGE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 E MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3975
Mailing Address - Country:US
Mailing Address - Phone:208-342-0212
Mailing Address - Fax:208-342-0323
Practice Address - Street 1:136 E MALLARD DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3975
Practice Address - Country:US
Practice Address - Phone:208-342-0212
Practice Address - Fax:208-342-0323
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD19391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics