Individual
DR. DOUGLAS STEVEN CALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
515 OLD TOLL RD, MADISON, CT 06443-1836
(203) 421-4100
(203) 421-4159
Mailing address
515 OLD TOLL RD, MADISON, CT 06443-1836
(203) 421-4100
(203) 421-4159
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7791
CT
1223G0001X
General Practice Dentistry
Primary
CT7791
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020007791CT
—
CT
Enumeration date
12/28/2006
Last updated
04/13/2015
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