MEDICARE: DR. VANESSA CALDERON D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	050-316	NY
2	122300000X	Dentist	050316	NY

General Provider Information

NPI Number	:	1023007226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA CALDERON D.M.D.

Provider Business Mailing Address
First Line	:	PO BOX 14890
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12212-4890
Country	:	US
Telephone Number	:	518-525-5634
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 COLUMBIA ST
Second Line	:
City	:	RENSSELAER
State	:	NY
Zip	:	12144-2933
Country	:	US
Telephone Number	:	518-463-9809
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	02/25/2020

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