Provider Demographics
NPI:1679692446
Name:MCCALMON, JACK D (DDS FAGD)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:D
Last Name:MCCALMON
Suffix:
Gender:M
Credentials:DDS FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8283 SOUTH WALKER
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139
Mailing Address - Country:US
Mailing Address - Phone:405-632-5561
Mailing Address - Fax:405-632-6301
Practice Address - Street 1:8283 SOUTH WALKER
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139
Practice Address - Country:US
Practice Address - Phone:405-632-5561
Practice Address - Fax:405-632-6301
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice