Charles Clark Kallstrom, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19014085 Issued in IL

Practice address

302 Randall Rd
Suite # 105
Geneva, IL 60134-4209

Phone

(630) 232-7385

Fax

(630) 232-7389

NPI assigned

Sep 4, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396847828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 RANDALL RD",
            "address_2": "SUITE # 105",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601344209",
            "telephone_number": "630-232-7385",
            "fax_number": "630-232-7389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 RANDALL RD",
            "address_2": "SUITE # 105",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601344209",
            "telephone_number": "630-232-7385",
            "fax_number": "630-232-7389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLSTROM",
        "first_name": "CHARLES",
        "middle_name": "CLARK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19014085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Jozwiak, M.D.
• Richard C Judycki II, OD
• Neelima D Kabre, MD
• Rachel Kaczmarek
• Lawrence Martin Kahan, LCPC
• Michael Todd Kaminski, D.C.
• Kane Anesthesia Associates, SC
• Kane Cardiac Diagnostics, LLC
• Kane Cardiology S.C.
• Kane Podiatry Associates, S.C.

• General Practice Dentistry in Geneva, IL
• Providers in Geneva, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.