Provider Demographics
NPI:1609027119
Name:CALVERT, JOHN FRANKLIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANKLIN
Last Name:CALVERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1803
Mailing Address - Street 2:180 FIRST ST., W. SUITE 103
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-1803
Mailing Address - Country:US
Mailing Address - Phone:208-471-8770
Mailing Address - Fax:208-726-0493
Practice Address - Street 1:180 1ST ST. W.
Practice Address - Street 2:SUITE 103
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-471-8770
Practice Address - Fax:207-726-0493
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4697122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID7576700001Medicare NSC