Provider Demographics
NPI:1720383540
Name:R. SAM CALLENDER DDS PC
Entity Type:Organization
Organization Name:R. SAM CALLENDER DDS PC
Other - Org Name:COLORADO SNORING AND SLEEP APNEA CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-422-3655
Mailing Address - Street 1:7207 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2505
Mailing Address - Country:US
Mailing Address - Phone:303-422-3655
Mailing Address - Fax:303-422-3776
Practice Address - Street 1:7207 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2505
Practice Address - Country:US
Practice Address - Phone:303-422-3655
Practice Address - Fax:303-422-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2851122300000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6485640001Medicare NSC