Provider Demographics
NPI:1124381744
Name:CALEK, DOMINIC G (DDS)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:G
Last Name:CALEK
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 1:23117 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-2809
Mailing Address - Country:US
Mailing Address - Phone:313-712-0084
Mailing Address - Fax:
Practice Address - Street 1:3375 S AIRPORT RD W
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7929
Practice Address - Country:US
Practice Address - Phone:231-486-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist