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General NPI Number Information
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NPI Number | 1023272531
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Entity Type | Individual
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Provider Name | ALFREDO RENE CALDERON DDS
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Gender | Male
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 12401 OLIVE BLVD
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City | CREVE COEUR
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State | MO
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Zip | 63141-5448
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Country | US
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Telephone | 314-275-9009
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Fax |
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Provider Business Mailing Address
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Address Line | 6529 CLAYTON AVE APT 2E
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City | SAINT LOUIS
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State | MO
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Zip | 63139-3368
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Country | US
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Telephone | 240-498-7453
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 60918
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2011013934
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019027929
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14777
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License Number State | MD
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