Provider Demographics
NPI:1073847265
Name:CHARLES K. DAHLGREN, MD CORPORATION
Entity Type:Organization
Organization Name:CHARLES K. DAHLGREN, MD CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAHLGREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-738-2555
Mailing Address - Street 1:1995 ERRECART BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8334
Mailing Address - Country:US
Mailing Address - Phone:775-738-2555
Mailing Address - Fax:775-738-2585
Practice Address - Street 1:1995 ERRECART BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8334
Practice Address - Country:US
Practice Address - Phone:775-738-2555
Practice Address - Fax:775-738-2585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11563207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty