Provider Demographics
NPI:1275951972
Name:KALSOW, OLEG (DMD)
Entity Type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:KALSOW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13555 AUTOMOBILE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-3826
Mailing Address - Country:US
Mailing Address - Phone:813-870-6000
Mailing Address - Fax:
Practice Address - Street 1:13555 AUTOMOBILE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3826
Practice Address - Country:US
Practice Address - Phone:813-870-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN214381223S0112X
MSPRV-FP-105-181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program