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General NPI Number Information
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NPI Number | 1821277435
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Entity Type | Individual
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Provider Name | ERICKSON CALZADO CALLEJO DDS
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Gender | Male
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 4095 MARSHALL RD
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City | KETTERING
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State | OH
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Zip | 45429-5111
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Country | US
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Telephone | 937-294-0776
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Fax | 937-298-7663
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Provider Business Mailing Address
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Address Line | 4095 MARSHALL RD
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City | KETTERING
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State | OH
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Zip | 45429-5111
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Country | US
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Telephone | 937-294-0776
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Fax | 937-298-7663
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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 | 19914
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License Number State | OH
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