Provider Demographics
NPI:1205044351
Name:CALLAHAN, PAUL F (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 HILTON AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2895
Mailing Address - Country:US
Mailing Address - Phone:516-741-3080
Mailing Address - Fax:
Practice Address - Street 1:61 HILTON AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2895
Practice Address - Country:US
Practice Address - Phone:516-741-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY035203OtherSTATE LICENSE NUMBER
NYAC 942713OtherDEA NUMBER