Healthcare Provider Details

I. General information

NPI: 1336163542
Provider Name (Legal Business Name): DONALD PAUL CALLAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10319 W. MARKHAM ST. SUITE 300
LITTLE ROCK AR
72205-4556
US

IV. Provider business mailing address

10319 W. MARKHAM ST. SUITE 300
LITTLE ROCK AR
72205-4556
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-1122
  • Fax: 501-224-1990
Mailing address:
  • Phone: 501-224-1122
  • Fax: 501-224-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2203
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: