Provider Demographics
NPI:1952423196
Name:CALHOUN, DAVID LAWRENCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:CALHOUN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 DIXIE HWY
Mailing Address - Street 2:SUITE 420
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4163
Mailing Address - Country:US
Mailing Address - Phone:502-448-4834
Mailing Address - Fax:502-448-7885
Practice Address - Street 1:3934 DIXIE HWY
Practice Address - Street 2:SUITE 420
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4163
Practice Address - Country:US
Practice Address - Phone:502-448-4834
Practice Address - Fax:502-448-7885
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5111OtherSTATE LICENSE #
KY60051117Medicaid