Provider Demographics
NPI:1528447398
Name:CALCAGNO, JACQUELINE ALICIA (DMD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ALICIA
Last Name:CALCAGNO
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 1:13350 PACIFIC PL UNIT 2302
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-8229
Mailing Address - Country:US
Mailing Address - Phone:732-977-4568
Mailing Address - Fax:
Practice Address - Street 1:5627 OBERLIN DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3748
Practice Address - Country:US
Practice Address - Phone:858-452-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15890122300000X
CA1041451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist