Provider Demographics
NPI:1750673562
Name:CALVI, RYAN MIKHAIL DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MIKHAIL DAVID
Last Name:CALVI
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 1:118 TILLEY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4450
Mailing Address - Country:US
Mailing Address - Phone:802-923-1005
Mailing Address - Fax:
Practice Address - Street 1:118 TILLEY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-4450
Practice Address - Country:US
Practice Address - Phone:802-923-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG3-0000381390200000X
PADS038714122300000X
VT016.01166391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist