Provider Demographics
NPI:1649479940
Name:CHARLES CALDER DDS MD PC
Entity type:Organization
Organization Name:CHARLES CALDER DDS MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:T
Authorized Official - Last Name:CALDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD DDS
Authorized Official - Phone:702-655-8400
Mailing Address - Street 1:6140 S FORT APACHE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-6702
Mailing Address - Country:US
Mailing Address - Phone:702-655-8400
Mailing Address - Fax:702-255-8409
Practice Address - Street 1:6140 S FORT APACHE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-6702
Practice Address - Country:US
Practice Address - Phone:702-655-8400
Practice Address - Fax:702-255-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS2-531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty