Healthcare Provider Details

I. General information

NPI: 1720383540
Provider Name (Legal Business Name): R. SAM CALLENDER DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7207 GRANDVIEW AVE
ARVADA CO
80002-2505
US

IV. Provider business mailing address

7207 GRANDVIEW AVE
ARVADA CO
80002-2505
US

V. Phone/Fax

Practice location:
  • Phone: 303-422-3655
  • Fax: 303-422-3776
Mailing address:
  • Phone: 303-422-3655
  • Fax: 303-422-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2851
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number2851
License Number StateCO

VIII. Authorized Official

Name: AMANDA KASSAL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 303-422-3655