Provider Demographics
NPI:1710023213
Name:ANTHONY P VARBONCOEUR DDC INC & CORTLAND S CALDEMEYER DDS APC GP
Entity Type:Organization
Organization Name:ANTHONY P VARBONCOEUR DDC INC & CORTLAND S CALDEMEYER DDS APC GP
Other - Org Name:P.THOMAS HISER DDS, MS, INC. - ANTHONY P. VARBONCOEUR DDS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORTLAND
Authorized Official - Middle Name:S
Authorized Official - Last Name:CALDEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-463-4486
Mailing Address - Street 1:5565 GROSSMONT CENTER DR
Mailing Address - Street 2:BLD 1 STE 129
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-463-4486
Mailing Address - Fax:619-463-6553
Practice Address - Street 1:5565 GROSSMONT CENTER DR
Practice Address - Street 2:BLD 1 STE 129
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-463-4486
Practice Address - Fax:619-463-6553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
47693122300000X
37512122300000X
1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty