Provider Demographics
NPI:1104995810
Name:CALDERON, MONICA (DMD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:CALDERON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 NW 110TH WAY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4119
Mailing Address - Country:US
Mailing Address - Phone:360-546-2695
Mailing Address - Fax:360-546-1363
Practice Address - Street 1:2501 NE 134TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3026
Practice Address - Country:US
Practice Address - Phone:360-546-2695
Practice Address - Fax:360-546-1363
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000080491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice