Provider Demographics
NPI:1952304735
Name:CALEM, DOUGLAS BART (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:BART
Last Name:CALEM
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 1:305 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702-7321
Mailing Address - Country:US
Mailing Address - Phone:570-323-4004
Mailing Address - Fax:
Practice Address - Street 1:305 S MARKET ST
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17702-7321
Practice Address - Country:US
Practice Address - Phone:570-323-4004
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021207L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice