Provider Demographics
NPI:1376319194
Name:KEVIN W. CALVERT DDS INC
Entity Type:Organization
Organization Name:KEVIN W. CALVERT DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-294-4403
Mailing Address - Street 1:373 MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3418
Mailing Address - Country:US
Mailing Address - Phone:408-294-4403
Mailing Address - Fax:408-971-8718
Practice Address - Street 1:373 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3418
Practice Address - Country:US
Practice Address - Phone:408-294-4403
Practice Address - Fax:408-971-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist