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General NPI Number Information
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NPI Number | 1750498374
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Entity Type | Individual
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Provider Name | ROBERT EDWARD MCCALLA DDS
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Gender | Male
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 875 UNION AVE DEPT OF GENERAL DENTISTRY
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City | MEMPHIS
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State | TN
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Zip | 38163-4367
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Country | US
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Telephone | 901-448-9596
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Fax |
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Provider Business Mailing Address
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Address Line | 10811 MONTEREY FOREST CV
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City | EADS
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State | TN
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Zip | 38028-9762
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Country | US
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Telephone | 901-861-0805
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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 | DS4007
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License Number State | TN
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