=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578777686
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM W. CALHOUN, D.D.S., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7800 USTICK RD
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83704-5848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-322-0040
-----------------------------------------------------
Fax | 208-322-0275
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7800 USTICK RD
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83704-5848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-322-0040
-----------------------------------------------------
Fax | 208-322-0275
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WILLIAM W. CALHOUN
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 208-322-0040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | D1846
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------