Provider Demographics
NPI:1750596284
Name:CALLANAN, KAREN MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARIE
Last Name:CALLANAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 N ROCK RD
Mailing Address - Street 2:BLDG. 2200, SUITE 101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1341
Mailing Address - Country:US
Mailing Address - Phone:316-636-9400
Mailing Address - Fax:
Practice Address - Street 1:3500 N ROCK RD
Practice Address - Street 2:BLDG. 2200, SUITE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1341
Practice Address - Country:US
Practice Address - Phone:316-636-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61481223G0001X
MD74171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice