MEDICARE: DR. CAROLINA CALLE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DE61484466	WA
2	1223P0221X	Pediatric Dentistry	37857	TX

General Provider Information

NPI Number	:	1861061681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLINA CALLE DDS

Provider Business Mailing Address
First Line	:	600 S MARINA WAY UNIT F309
Second Line	:
City	:	WASHOUGAL
State	:	WA
Zip	:	98671-2198
Country	:	US
Telephone Number	:	678-268-8779
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 SE 117TH AVE STE 150
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98683-5298
Country	:	US
Telephone Number	:	360-209-1089
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	01/18/2026

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Directions to “ DR. CAROLINA CALLE DDS” Practice Location

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