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General NPI Number Information
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NPI Number | 1205234374
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Entity Type | Individual
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Provider Name | MICHAEL CALLEJAS DMD
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Gender | Male
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Dates
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Enumeration Date | 12/05/2014
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 14416 JEFFERSON DAVIS HWY
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City | SUITE 16
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State | VA
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Zip | 22191
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Country | US
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Telephone | 703-492-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 5240 DUKE ST APT 106
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City | ALEXANDRIA
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State | VA
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Zip | 22304-2951
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Country | US
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Telephone | 240-507-9368
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401414549
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License Number State | VA
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