Provider Demographics
NPI:1528197845
Name:KALB, ANTHONY J JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:KALB
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:J
Other - Last Name:KALB
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:968 W 3RD ST
Mailing Address - Street 2:STE 200
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6607
Mailing Address - Country:US
Mailing Address - Phone:563-582-6203
Mailing Address - Fax:563-582-6508
Practice Address - Street 1:968 W 3RD ST
Practice Address - Street 2:STE 200
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6607
Practice Address - Country:US
Practice Address - Phone:563-582-6203
Practice Address - Fax:563-582-6508
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA66761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA#215491OtherDELTA DENTAL OF IOWA
IA#0090407Medicaid