Healthcare Provider Details

I. General information

NPI: 1790066827
Provider Name (Legal Business Name): MAUREEN CALLENDER DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3422 12TH AVE NE
OLYMPIA WA
98506-5175
US

IV. Provider business mailing address

3422 12TH AVE NE
OLYMPIA WA
98506-5175
US

V. Phone/Fax

Practice location:
  • Phone: 360-459-5885
  • Fax:
Mailing address:
  • Phone: 360-459-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60285867
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: