Provider Demographics
NPI:1578786281
Name:CALDERON, EMELITO TAPANG (DDS)
Entity Type:Individual
Prefix:
First Name:EMELITO
Middle Name:TAPANG
Last Name:CALDERON
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 1:9036 RESEDA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5897
Mailing Address - Country:US
Mailing Address - Phone:818-701-5210
Mailing Address - Fax:818-701-5208
Practice Address - Street 1:9036 RESEDA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5897
Practice Address - Country:US
Practice Address - Phone:818-701-5210
Practice Address - Fax:818-701-5208
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA474581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9384401Medicaid