Provider Demographics
NPI:1033848122
Name:KALKSTEIN, JAKE SAMUEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JAKE
Middle Name:SAMUEL
Last Name:KALKSTEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 LINCOLN ST E
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-2769
Mailing Address - Country:US
Mailing Address - Phone:330-454-2000
Mailing Address - Fax:855-634-9302
Practice Address - Street 1:2725 LINCOLN ST E
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-2769
Practice Address - Country:US
Practice Address - Phone:330-454-2000
Practice Address - Fax:330-488-0323
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17943122300000X
OH30.0276461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist