Provider Demographics
NPI:1730653197
Name:MATTHEW CALLAN DDS PLLC
Entity Type:Organization
Organization Name:MATTHEW CALLAN DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:CALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:360-479-4050
Mailing Address - Street 1:2530 PERRY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-5219
Mailing Address - Country:US
Mailing Address - Phone:360-479-4050
Mailing Address - Fax:
Practice Address - Street 1:2530 PERRY AVE STE 100
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-5219
Practice Address - Country:US
Practice Address - Phone:360-479-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty