Provider Demographics
NPI:1932534724
Name:ALEX J CALLEJAS DMD, LLC
Entity Type:Organization
Organization Name:ALEX J CALLEJAS DMD, LLC
Other - Org Name:KENDALL SQUARE DENTAL ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:J
Authorized Official - Last Name:CALLEJAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-888-1613
Mailing Address - Street 1:1 KENDALL SQ
Mailing Address - Street 2:SUITE 3104
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1562
Mailing Address - Country:US
Mailing Address - Phone:617-577-8700
Mailing Address - Fax:
Practice Address - Street 1:1 KENDALL SQ
Practice Address - Street 2:SUITE 3104
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1562
Practice Address - Country:US
Practice Address - Phone:617-577-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty