MEDICARE: CHARLES CALDER DDS MD PC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	S2-53	NV

General Provider Information

NPI Number	:	1649479940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES CALDER DDS MD PC

Provider Business Mailing Address
First Line	:	6140 S FORT APACHE RD
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6702
Country	:	US
Telephone Number	:	702-655-8400
Fax Number	:	702-255-8409

Provider Business Practice Location Address
First Line	:	6140 S FORT APACHE RD
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6702
Country	:	US
Telephone Number	:	702-655-8400
Fax Number	:	702-255-8409

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES T CALDER JR.
Credential	:	MD DDS
Telephone Number	:	702-655-8400

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	07/16/2007

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