MEDICARE: DR. CHRISTOPHER JAY MCCALLUM D.M.D.

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	1223E0200X	Endodontics	4389	AL

General Provider Information

NPI Number	:	1871709238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JAY MCCALLUM D.M.D.

Provider Business Mailing Address
First Line	:	2531 ROCKY RIDGE RD
Second Line	:	SUITE 122
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-4445
Country	:	US
Telephone Number	:	205-824-0018
Fax Number	:	205-824-1416

Provider Business Practice Location Address
First Line	:	2531 ROCKY RIDGE RD
Second Line	:	SUITE 122
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-4445
Country	:	US
Telephone Number	:	205-824-0018
Fax Number	:	205-824-1416

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/20/2015

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