Provider Demographics
NPI:1366465312
Name:CALLENDER, RICHARD SAM (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SAM
Last Name:CALLENDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:R
Other - Middle Name:SAM
Other - Last Name:CALLENDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:7207 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002
Mailing Address - Country:US
Mailing Address - Phone:303-422-3622
Mailing Address - Fax:303-422-3776
Practice Address - Street 1:7207 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002
Practice Address - Country:US
Practice Address - Phone:303-422-3622
Practice Address - Fax:303-422-3776
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO28511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics