Callis, Douglas Steven

Callis, Douglas Steven is an sole proprietor health care provider with primary practice located at 515 Old Toll Rd , Madison CT 06443-1836. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / General Practice is his primary health care specialty. Callis, Douglas Steven can be contacted via phone (203) 421-4100.

Contact Information

Primary practice address
515 Old Toll Rd Madison CT 06443-1836
Phone: (203) 421-4100
Fax: (203) 421-4159
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 7791 Connecticut
Dental Providers / General Practice 1223G0001X CT7791 Connecticut

Profile Details

NPI number 1659437580
LBN Legal business name Callis, Douglas Steven
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 28th, 2006
Last updated Apr 13th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659437580 NPPES
Connecticut MEDICAID 020007791CT

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