Provider Demographics
NPI:1770633190
Name:CALLAHAN, DUANE DESPAIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:DESPAIN
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11281 MILLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-5377
Mailing Address - Country:US
Mailing Address - Phone:801-553-1547
Mailing Address - Fax:801-569-1701
Practice Address - Street 1:8045 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0534
Practice Address - Country:US
Practice Address - Phone:081-255-3351
Practice Address - Fax:801-569-1701
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT276294-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice