Provider Demographics
NPI:1811258627
Name:MIKE E. CALDERON DDS PC
Entity type:Organization
Organization Name:MIKE E. CALDERON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:ELVIS
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-666-1392
Mailing Address - Street 1:1221 SUNRISE HWY.
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-666-1392
Mailing Address - Fax:631-666-1520
Practice Address - Street 1:720 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4411
Practice Address - Country:US
Practice Address - Phone:631-666-1392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045-794122300000X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Single Specialty