Provider Demographics
NPI:1861061681
Name:CALLE, CAROLINA (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:
Last Name:CALLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S MARINA WAY UNIT F309
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-2198
Mailing Address - Country:US
Mailing Address - Phone:678-268-8779
Mailing Address - Fax:
Practice Address - Street 1:601 SE 117TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5298
Practice Address - Country:US
Practice Address - Phone:360-209-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE614844661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty