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General NPI Number Information
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NPI Number | 1972511947
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Entity Type | Organization
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Legal Business Name | JOHN R CALLAHAN DDS ASSOC
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 E WARD AVE
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City | RIDLEY PARK
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State | PA
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Zip | 19078
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Country | US
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Telephone | 610-532-3921
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E WARD AVE
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City | RIDLEY PARK
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State | PA
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Zip | 19078
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Country | US
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Telephone | 610-532-3921
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Fax |
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Authorized Official
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Title or Position | PRES JOHN C CALLAHAN DDS ASSOC
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Name | JOHN R CALLAHAN
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Credential | DDS
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Telephone | 610-532-3921
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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 | PA 12658
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License Number State | PA
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