Provider Demographics
NPI:1649021973
Name:CALCIUM DENTAL
Entity type:Organization
Organization Name:CALCIUM DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIONDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:VENABLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:724-734-3593
Mailing Address - Street 1:12060 ABBERLY PL APT 203
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2715
Mailing Address - Country:US
Mailing Address - Phone:724-734-3593
Mailing Address - Fax:
Practice Address - Street 1:15805 ROBERT CRAIN HIGHWAY SW
Practice Address - Street 2:SUITE E
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613
Practice Address - Country:US
Practice Address - Phone:724-734-3593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty