Provider Demographics
NPI:1518587484
Name:RHOADS, CALVIN ANDREW (DMD)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:ANDREW
Last Name:RHOADS
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:PO BOX 1529
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-1529
Mailing Address - Country:US
Mailing Address - Phone:907-766-6372
Mailing Address - Fax:907-766-2581
Practice Address - Street 1:216 DALTON STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827
Practice Address - Country:US
Practice Address - Phone:907-766-6372
Practice Address - Fax:907-766-2581
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10651122300000X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist