Provider Demographics
NPI:1356343230
Name:CALLSTROM, DANIEL CURTIS (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CURTIS
Last Name:CALLSTROM
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 1:114 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:CANNON FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55009-2011
Mailing Address - Country:US
Mailing Address - Phone:507-263-4501
Mailing Address - Fax:507-263-5691
Practice Address - Street 1:114 3RD ST N
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-2011
Practice Address - Country:US
Practice Address - Phone:507-263-4501
Practice Address - Fax:507-263-5691
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist