Provider Demographics
NPI:1679553614
Name:KALANTA, KEVIN THEODORE (DDS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:THEODORE
Last Name:KALANTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6618 FROST LAKE LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-2647
Mailing Address - Country:US
Mailing Address - Phone:850-529-1535
Mailing Address - Fax:202-762-3753
Practice Address - Street 1:2300 E ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20372-5300
Practice Address - Country:US
Practice Address - Phone:202-762-3537
Practice Address - Fax:202-762-3753
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-165011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice