Provider Demographics
NPI:1477728145
Name:CHARLES CALHOUN DDS, PC
Entity Type:Organization
Organization Name:CHARLES CALHOUN DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-250-8861
Mailing Address - Street 1:10016 S MINGO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5784
Mailing Address - Country:US
Mailing Address - Phone:918-250-8861
Mailing Address - Fax:918-250-3761
Practice Address - Street 1:10016 S MINGO RD
Practice Address - Street 2:SUITE B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5784
Practice Address - Country:US
Practice Address - Phone:918-250-8861
Practice Address - Fax:918-250-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK4915122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty