Healthcare Provider Details

I. General information

NPI: 1417021825
Provider Name (Legal Business Name): RANDALL REX CALVERT DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14420 BEL RED ROAD 207
BELLEVUE WA
98007
US

IV. Provider business mailing address

14420 BEL RED ROAD 207
BELLEVUE WA
98007
US

V. Phone/Fax

Practice location:
  • Phone: 425-641-6331
  • Fax: 425-641-6388
Mailing address:
  • Phone: 425-641-6331
  • Fax: 425-641-6388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE00006407
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: