Provider Demographics
NPI:1699783720
Name:MCCALL, MICHAEL JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:MCCALL
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 1:306 MAIN STREET
Mailing Address - Street 2:P.O. BOX 458
Mailing Address - City:KAMIAH
Mailing Address - State:ID
Mailing Address - Zip Code:83536
Mailing Address - Country:US
Mailing Address - Phone:208-935-2143
Mailing Address - Fax:
Practice Address - Street 1:306 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KAMIAH
Practice Address - State:ID
Practice Address - Zip Code:83536
Practice Address - Country:US
Practice Address - Phone:208-935-2143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID66D-18561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice