Provider Demographics
NPI:1407015639
Name:CALLEJAS, DILMAR ELIEL (DMD)
Entity Type:Individual
Prefix:
First Name:DILMAR
Middle Name:ELIEL
Last Name:CALLEJAS
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 1:313 N TIBBS RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8026
Mailing Address - Country:US
Mailing Address - Phone:706-259-3318
Mailing Address - Fax:706-259-3319
Practice Address - Street 1:2880 CLEVELAND HWY
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8002
Practice Address - Country:US
Practice Address - Phone:706-259-3318
Practice Address - Fax:706-259-3319
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0137271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice