MEDICARE: DR. RICHARD FREDERICK CALLAHAN 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	19-01-3243	IL

General Provider Information

NPI Number	:	1457579054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD FREDERICK CALLAHAN D.D.S.

Provider Business Mailing Address
First Line	:	5133 WASHINGTON ST STE 7
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-4757
Country	:	US
Telephone Number	:	630-964-9882
Fax Number	:	630-971-3221

Provider Business Practice Location Address
First Line	:	5133 WASHINGTON ST STE 7
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-4757
Country	:	US
Telephone Number	:	630-964-9882
Fax Number	:	630-971-3221

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

Provider Enumeration Date	:	04/22/2007
Last Update Date	:	07/08/2007

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