Provider Demographics
NPI:1760073761
Name:CALANTOG, ALDEN JERALD
Entity type:Individual
Prefix:
First Name:ALDEN
Middle Name:JERALD
Last Name:CALANTOG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5382 BAMBOO LN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1813
Mailing Address - Country:US
Mailing Address - Phone:510-552-9461
Mailing Address - Fax:
Practice Address - Street 1:5382 BAMBOO LN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1813
Practice Address - Country:US
Practice Address - Phone:510-552-9461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1081411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program