Provider Demographics
NPI:1891720306
Name:CALLAGHAN, JODEEN FAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JODEEN
Middle Name:FAY
Last Name:CALLAGHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-6330
Mailing Address - Country:US
Mailing Address - Phone:360-696-9009
Mailing Address - Fax:360-896-4489
Practice Address - Street 1:4900 IDAHO ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6330
Practice Address - Country:US
Practice Address - Phone:360-696-9009
Practice Address - Fax:360-896-4489
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00062491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice