Healthcare Provider Details

I. General information

NPI: 1619396827
Provider Name (Legal Business Name): KAISHA CALVIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ARMY DENTAL HEALTH ACTIVITY 7223 MISSISSIPPI AVENUE
FORT POLK LA
71459
US

IV. Provider business mailing address

7223 MISSISSIPPI AVE BLDG 1561
FORT POLK LA
71459
US

V. Phone/Fax

Practice location:
  • Phone: 726-780-1311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14033653-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: