Provider Demographics
NPI:1508076878
Name:CALICDAN, ROMULO (DDS)
Entity Type:Individual
Prefix:
First Name:ROMULO
Middle Name:
Last Name:CALICDAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15209 BEAR VALLEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1610
Mailing Address - Country:US
Mailing Address - Phone:760-241-3336
Mailing Address - Fax:
Practice Address - Street 1:15209 BEAR VALLEY RD STE A
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1610
Practice Address - Country:US
Practice Address - Phone:760-241-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA427251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice