MEDICARE: DR. RALPH A CALLENDER SR. D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	16884	CA

General Provider Information

NPI Number	:	1316159783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH A CALLENDER SR. D.D.S.

Provider Business Mailing Address
First Line	:	3701 STOCKER ST
Second Line	:	SUITE 304
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-5108
Country	:	US
Telephone Number	:	323-296-6711
Fax Number	:	310-645-5105

Provider Business Practice Location Address
First Line	:	3701 STOCKER ST
Second Line	:	SUITE 304
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-5108
Country	:	US
Telephone Number	:	323-296-6711
Fax Number	:	310-645-5105

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

Provider Enumeration Date	:	05/05/2007
Last Update Date	:	06/22/2009

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