Provider Demographics
NPI:1053150862
Name:WARING, CALLUM (DMD)
Entity type:Individual
Prefix:DR
First Name:CALLUM
Middle Name:
Last Name:WARING
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 1:1301 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-5779
Mailing Address - Country:US
Mailing Address - Phone:580-772-7747
Mailing Address - Fax:
Practice Address - Street 1:1301 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5779
Practice Address - Country:US
Practice Address - Phone:580-772-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK78281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice