Provider Demographics
NPI:1306868500
Name:CALLEJA, SHERI DIANE (DDS)
Entity type:Individual
Prefix:DR
First Name:SHERI
Middle Name:DIANE
Last Name:CALLEJA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 UNION LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3551
Mailing Address - Country:US
Mailing Address - Phone:248-363-3100
Mailing Address - Fax:248-366-8735
Practice Address - Street 1:2420 UNION LAKE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-3551
Practice Address - Country:US
Practice Address - Phone:248-363-3100
Practice Address - Fax:248-366-8735
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010158651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice