Provider Demographics
NPI:1851434096
Name:CALDEMEYER, ALLAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:C
Last Name:CALDEMEYER
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 1:2554 WOODMEADOW DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8033
Mailing Address - Country:US
Mailing Address - Phone:616-949-3581
Mailing Address - Fax:616-949-2588
Practice Address - Street 1:2554 WOODMEADOW DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8033
Practice Address - Country:US
Practice Address - Phone:616-949-3581
Practice Address - Fax:616-949-2588
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010105121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901010512OtherSTATE LICENSE NUMBER