Provider Demographics
NPI:1508963554
Name:CALVERT, DENNIS WADE (DDS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:WADE
Last Name:CALVERT
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 1:150 N JACKSON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1908
Mailing Address - Country:US
Mailing Address - Phone:408-272-7600
Mailing Address - Fax:408-272-7621
Practice Address - Street 1:150 N JACKSON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1908
Practice Address - Country:US
Practice Address - Phone:408-272-7600
Practice Address - Fax:408-272-7621
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA238051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics