Provider Demographics
NPI:1245331552
Name:CALLAHAN, CLINTON T (DMD)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:T
Last Name:CALLAHAN
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 1:13335 VOYAGER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7657
Mailing Address - Country:US
Mailing Address - Phone:719-265-9600
Mailing Address - Fax:719-265-9899
Practice Address - Street 1:13335 VOYAGER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921
Practice Address - Country:US
Practice Address - Phone:719-265-9600
Practice Address - Fax:719-265-9899
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry