Provider Demographics
NPI:1558551689
Name:RALPH A CALLENDER DDS CORP.
Entity Type:Organization
Organization Name:RALPH A CALLENDER DDS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CALLENDER
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-296-6711
Mailing Address - Street 1:3701 STOCKER ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5108
Mailing Address - Country:US
Mailing Address - Phone:323-296-6711
Mailing Address - Fax:310-645-5105
Practice Address - Street 1:3701 STOCKER ST
Practice Address - Street 2:SUITE 304
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-5108
Practice Address - Country:US
Practice Address - Phone:323-296-6711
Practice Address - Fax:310-645-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA168841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA500179Medicaid