Provider Demographics
NPI:1396151569
Name:RICHARD L. CALLENDER, DDS, PC
Entity type:Organization
Organization Name:RICHARD L. CALLENDER, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, PERSONAL CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-282-5930
Mailing Address - Street 1:120 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-1835
Mailing Address - Country:US
Mailing Address - Phone:701-282-5930
Mailing Address - Fax:701-282-0017
Practice Address - Street 1:120 1ST ST
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-1835
Practice Address - Country:US
Practice Address - Phone:701-282-5930
Practice Address - Fax:701-282-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND15091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND00040519Medicaid