Provider Demographics
NPI:1912459462
Name:KALAMCHI PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KALAMCHI PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SABAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KALAMCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-945-2310
Mailing Address - Street 1:8112 N 87TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2368
Mailing Address - Country:US
Mailing Address - Phone:480-945-2310
Mailing Address - Fax:480-941-1362
Practice Address - Street 1:8112 N 87TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2368
Practice Address - Country:US
Practice Address - Phone:480-945-2310
Practice Address - Fax:480-941-1362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD04070204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZDDS4070AMedicare UPIN