Provider Demographics
NPI:1790842607
Name:JOSEPH V CALDERONE JR DMD PA
Entity Type:Organization
Organization Name:JOSEPH V CALDERONE JR DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:V
Authorized Official - Last Name:CALDERONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:386-668-8600
Mailing Address - Street 1:415 SUMMERHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2716
Mailing Address - Country:US
Mailing Address - Phone:386-668-8600
Mailing Address - Fax:386-668-0031
Practice Address - Street 1:415 SUMMERHAVEN DR
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2716
Practice Address - Country:US
Practice Address - Phone:386-668-8600
Practice Address - Fax:386-668-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 9410122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
60135OtherBLUE CROSS BLUE SHIELD