Provider Demographics
NPI:1205980604
Name:KALLIO, DONALD MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MICHAEL
Last Name:KALLIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BRIDGE ST
Mailing Address - Street 2:CORLISS LANDING
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4362
Mailing Address - Country:US
Mailing Address - Phone:401-861-5000
Mailing Address - Fax:401-861-5603
Practice Address - Street 1:16 BRIDGE ST
Practice Address - Street 2:CORLISS LANDING
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4362
Practice Address - Country:US
Practice Address - Phone:401-861-5000
Practice Address - Fax:401-861-5603
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI024961223P0300X
MA110231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics