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General NPI Number Information
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NPI Number | 1992022925
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Entity Type | Individual
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Provider Name | MATTHEW JAMES CALLAN DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 04/30/2010
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 2530 PERRY AVE STE 100
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City | BREMERTON
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State | WA
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Zip | 98310-5219
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Country | US
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Telephone | 360-479-4050
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Fax | 360-377-4337
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Provider Business Mailing Address
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Address Line | 2530 PERRY AVE STE 100
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City | BREMERTON
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State | WA
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Zip | 98310-5219
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Country | US
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Telephone | 360-479-4050
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Fax | 360-377-4337
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DE60486958
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License Number State | WA
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