Provider Demographics
NPI:1013983931
Name:CALLICUTT, VICTORIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:CALLICUTT
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 1:1240 UPPER HEMBREE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1144
Mailing Address - Country:US
Mailing Address - Phone:770-753-0067
Mailing Address - Fax:770-753-0994
Practice Address - Street 1:1240 UPPER HEMBREE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1144
Practice Address - Country:US
Practice Address - Phone:770-753-0067
Practice Address - Fax:770-753-0994
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011273122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist