Provider Demographics
NPI:1275799090
Name:CALLEA, CHARLES JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JAMES
Last Name:CALLEA
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 1:502 N PLUM GROVE RD
Mailing Address - Street 2:STE. C
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-8204
Mailing Address - Country:US
Mailing Address - Phone:847-934-3367
Mailing Address - Fax:847-934-5623
Practice Address - Street 1:502 N PLUM GROVE RD
Practice Address - Street 2:STE. C
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8204
Practice Address - Country:US
Practice Address - Phone:847-934-3367
Practice Address - Fax:847-934-5623
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190183811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice