Provider Demographics
NPI:1619396827
Name:CALVIN, KAISHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAISHA
Middle Name:
Last Name:CALVIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7223 MISSISSIPPI AVE
Mailing Address - Street 2:BLDG 1561
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:US ARMY DENTAL HEALTH ACTIVITY
Practice Address - Street 2:7223 MISSISSIPPI AVENUE
Practice Address - City:FORT JOHNSON
Practice Address - State:LA
Practice Address - Zip Code:71459
Practice Address - Country:US
Practice Address - Phone:337-531-4815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD154941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice