Provider Demographics
NPI:1811026057
Name:CALLEJO, MARIA ANNETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ANNETTE
Last Name:CALLEJO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S RIVER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-2240
Mailing Address - Country:US
Mailing Address - Phone:937-746-9971
Mailing Address - Fax:937-704-9119
Practice Address - Street 1:314 S RIVER ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-2240
Practice Address - Country:US
Practice Address - Phone:937-746-9971
Practice Address - Fax:937-704-9119
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH206341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice