Provider Demographics
NPI:1255305702
Name:CALIXTO, LUIS EDUARDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:EDUARDO
Last Name:CALIXTO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6368 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-2643
Mailing Address - Country:US
Mailing Address - Phone:619-287-8437
Mailing Address - Fax:619-287-8028
Practice Address - Street 1:6368 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-2643
Practice Address - Country:US
Practice Address - Phone:619-287-8437
Practice Address - Fax:619-287-8028
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB41363-01OtherDENTI-CAL
CA808544OtherUNITED CONCORDIA INS.