Provider Demographics
NPI:1053533745
Name:CALIFANO, JOSEPH VINCENT (DDS, PHD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:VINCENT
Last Name:CALIFANO
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 SW MOODY AVE
Mailing Address - Street 2:MAIL CODE SD-PERI
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5042
Mailing Address - Country:US
Mailing Address - Phone:503-346-4772
Mailing Address - Fax:503-494-8351
Practice Address - Street 1:2730 SW MOODY AVE
Practice Address - Street 2:MAIL CODE SD-PERI
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5042
Practice Address - Country:US
Practice Address - Phone:503-346-4772
Practice Address - Fax:503-494-8351
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD101871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053533745OtherNPI