Provider Demographics
NPI:1184973141
Name:ANTHONY LLYNN CALLISON D.D.S. P.C.
Entity type:Organization
Organization Name:ANTHONY LLYNN CALLISON D.D.S. P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-286-9024
Mailing Address - Street 1:P.O. BOX 702620
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-2620
Mailing Address - Country:US
Mailing Address - Phone:405-286-9024
Mailing Address - Fax:405-286-9088
Practice Address - Street 1:2001 E SANTA FE ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1608
Practice Address - Country:US
Practice Address - Phone:913-839-1490
Practice Address - Fax:913-440-9959
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY DENTIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-06
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60795122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty