Provider Demographics
NPI:1578993184
Name:CALLAHAN, CHAD E (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:E
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8605
Mailing Address - Country:US
Mailing Address - Phone:850-478-4788
Mailing Address - Fax:850-474-6461
Practice Address - Street 1:1007 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8605
Practice Address - Country:US
Practice Address - Phone:850-478-4788
Practice Address - Fax:850-474-6461
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL165321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics