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NPI Code Detail

MEDICARE: DR. JOHN N KALLIS DMD

MEDICARE: DR. JOHN N KALLIS DMD
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
11223P0106XOral and Maxillofacial Pathology DentistryDI15472NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821086901
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN N KALLIS DMD
Provider Business Mailing Address
First Line : 617 E PALISADE AVE
Second Line :
City : ENGLEWOOD CLIFFS
State : NJ
Zip : 07632-1831
Country : US
Telephone Number : 201-567-7500
Fax Number : 201-567-7505
Provider Business Practice Location Address
First Line : 617 E PALISADE AVE
Second Line :
City : ENGLEWOOD CLIFFS
State : NJ
Zip : 07632-1831
Country : US
Telephone Number : 201-567-7500
Fax Number : 201-567-7505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2005
Last Update Date : 12/29/2009

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