MEDICARE: JAMES C. CALVIN DDS P.C

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	122300000X	Dentist	6762	CO

General Provider Information

NPI Number	:	1629183215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES C. CALVIN DDS P.C

Provider Business Mailing Address
First Line	:	1512 NORTH UNION BLVD SUITE 101
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2884
Country	:	US
Telephone Number	:	719-633-2266
Fax Number	:	719-578-8184

Provider Business Practice Location Address
First Line	:	1512 NORTH UNION BLVD SUITE 101
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2884
Country	:	US
Telephone Number	:	719-633-2266
Fax Number	:	719-578-8184

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES C CALVIN
Credential	:	DDS
Telephone Number	:	719-633-2266

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/16/2018

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