Provider Demographics
NPI:1083739478
Name:CHARLTON, DANIEL JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:CHARLTON
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 1:13983 MANGO DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3131
Mailing Address - Country:US
Mailing Address - Phone:858-481-8848
Mailing Address - Fax:858-481-6358
Practice Address - Street 1:13983 MANGO DR
Practice Address - Street 2:SUITE 101
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3131
Practice Address - Country:US
Practice Address - Phone:858-481-8848
Practice Address - Fax:858-481-6358
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA866637OtherUNITED CONCORDIA PROVIDER