Provider Demographics
NPI:1487134458
Name:CALANDRELLI, GIAN (DMD)
Entity type:Individual
Prefix:
First Name:GIAN
Middle Name:
Last Name:CALANDRELLI
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 1:150 QUARRY ST APT 303
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4167
Mailing Address - Country:US
Mailing Address - Phone:401-525-1981
Mailing Address - Fax:
Practice Address - Street 1:250 WAMPANOAG TRL STE 103
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2215
Practice Address - Country:US
Practice Address - Phone:401-273-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-18
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN034091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice