Individual
MIKE E CALDERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
720 MONTAUK HWY, WEST ISLIP, NY 11795-4411
(631) 666-1392
(631) 666-1520
Mailing address
720 MONTAUK HWY, WEST ISLIP, NY 11795-4411
(631) 666-1392
(631) 666-1520
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
045 794
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
045794
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02168867
—
NY
Enumeration date
02/07/2007
Last updated
04/29/2021
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