Provider Demographics
NPI:1275186637
Name:EASTWOOD, CALVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:
Last Name:EASTWOOD
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 1:3088 BASSWOOD BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-1676
Mailing Address - Country:US
Mailing Address - Phone:817-382-7445
Mailing Address - Fax:
Practice Address - Street 1:3088 BASSWOOD BLVD STE 150
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1676
Practice Address - Country:US
Practice Address - Phone:817-382-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX355341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice