Healthcare Provider Details

I. General information

NPI: 1245331552
Provider Name (Legal Business Name): CLINTON T. CALLAHAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13335 VOYAGER PKWY STE 100
COLORADO SPRINGS CO
80921
US

IV. Provider business mailing address

13335 VOYAGER PKWY STE 100
COLORADO SPRINGS CO
80921-7657
US

V. Phone/Fax

Practice location:
  • Phone: 719-265-9600
  • Fax: 719-265-9899
Mailing address:
  • Phone: 719-265-9600
  • Fax: 719-265-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8468
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: