Provider Demographics
NPI:1043382088
Name:YOURSTOWSKY, CHARLES JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOHN
Last Name:YOURSTOWSKY
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 1:3665 STUTZ DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9144
Mailing Address - Country:US
Mailing Address - Phone:330-533-7700
Mailing Address - Fax:
Practice Address - Street 1:3665 STUTZ DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9144
Practice Address - Country:US
Practice Address - Phone:330-533-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30018141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist