Provider Demographics
NPI:1932249950
Name:CALLOWAY, VOLLIE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:VOLLIE
Middle Name:A
Last Name:CALLOWAY
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 1:1319 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1012
Mailing Address - Country:US
Mailing Address - Phone:209-946-0335
Mailing Address - Fax:209-546-0641
Practice Address - Street 1:1319 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1012
Practice Address - Country:US
Practice Address - Phone:209-946-0335
Practice Address - Fax:209-546-0641
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA356861223G0001X
CAB35686-01122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist