Provider Demographics
NPI:1205972494
Name:CALLEJAS, SUSAN (DMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:CALLEJAS
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 1:404 CROYDEN RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1612
Mailing Address - Country:US
Mailing Address - Phone:305-582-7517
Mailing Address - Fax:
Practice Address - Street 1:6909 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1702
Practice Address - Country:US
Practice Address - Phone:215-742-4343
Practice Address - Fax:215-742-4436
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16676122300000X
PADS036472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist