Individual
DR. CHARLES CLARK KALLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
302 RANDALL RD, SUITE # 105, GENEVA, IL 60134-4209
(630) 232-7385
(630) 232-7389
Mailing address
302 RANDALL RD, SUITE # 105, GENEVA, IL 60134-4209
(630) 232-7385
(630) 232-7389
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19014085
IL
Other
Enumeration date
09/04/2006
Last updated
07/08/2007
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