# MIKE E. CALDERON DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811258627
- **Authorized official:** MIKE ELVIS CALDERON D.D.S. (DENTIST)
- **Authorized official phone:** (631) 666-1392

## Contact information

- **Practice address:** 720 MONTAUK HWY, WEST ISLIP, NY 11795-4411
- **Practice address phone:** (631) 666-1392
- **Mailing address:** 1221 SUNRISE HWY., BAY SHORE, NY 11706
- **Mailing address phone:** (631) 666-1392
- **Mailing address fax:** (631) 666-1520

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 045-794 | NY | — |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/07/2012
- **Last updated:** 05/06/2021