Provider Demographics
NPI:1235241407
Name:CALKINS, WILFRED DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILFRED
Middle Name:DENNIS
Last Name:CALKINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:DENNIS
Other - Last Name:CALKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:MANZANITA
Mailing Address - State:OR
Mailing Address - Zip Code:97130-1107
Mailing Address - Country:US
Mailing Address - Phone:503-368-5077
Mailing Address - Fax:
Practice Address - Street 1:2925 DEBARR RD
Practice Address - Street 2:DENTAL SERVICE (160)
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2983
Practice Address - Country:US
Practice Address - Phone:907-257-4940
Practice Address - Fax:907-257-4953
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND77421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice