Provider Demographics
NPI:1336163542
Name:CALLAN, DONALD PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:PAUL
Last Name:CALLAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10319 W. MARKHAM ST.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4556
Mailing Address - Country:US
Mailing Address - Phone:501-224-1122
Mailing Address - Fax:501-224-1990
Practice Address - Street 1:10319 W. MARKHAM ST.
Practice Address - Street 2:SUITE 300
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4556
Practice Address - Country:US
Practice Address - Phone:501-224-1122
Practice Address - Fax:501-224-1990
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR22031223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58556OtherBLUE CROSS BLUE SHIELD
ART75499Medicare UPIN