Provider Demographics
NPI:1043493687
Name:MCCALL, EDWARD H (EDWARD MCCALL)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:MCCALL
Suffix:
Gender:M
Credentials:EDWARD MCCALL
Other - Prefix:DR
Other - First Name:EDWARD
Other - Middle Name:H
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:143 CALISTOGA LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-8103
Mailing Address - Country:US
Mailing Address - Phone:916-543-0730
Mailing Address - Fax:
Practice Address - Street 1:143 CALISTOGA LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-8103
Practice Address - Country:US
Practice Address - Phone:916-543-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist