Provider Demographics
NPI:1629026976
Name:SHIROMA, CALVIN YOSHITO (DMD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:YOSHITO
Last Name:SHIROMA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 E 56TH AVE
Mailing Address - Street 2:D105
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1611
Mailing Address - Country:US
Mailing Address - Phone:907-223-9471
Mailing Address - Fax:
Practice Address - Street 1:724 POSTAL SERVICE LOOP
Practice Address - Street 2:#7500, BLDG. 634
Practice Address - City:FORT RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99505-5001
Practice Address - Country:US
Practice Address - Phone:907-384-3706
Practice Address - Fax:907-384-3080
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-1548122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist