Provider Demographics
NPI:1154874196
Name:MONICA CALDERON, DMD PS
Entity type:Organization
Organization Name:MONICA CALDERON, DMD PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-546-2695
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 STE 202
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3028
Practice Address - Country:US
Practice Address - Phone:360-546-2695
Practice Address - Fax:360-546-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000080491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty