Provider Demographics
NPI:1083808588
Name:AZZARETTI, CHARLES D (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:AZZARETTI
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 1:439 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3404
Mailing Address - Country:US
Mailing Address - Phone:914-666-3310
Mailing Address - Fax:914-666-7924
Practice Address - Street 1:439 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3404
Practice Address - Country:US
Practice Address - Phone:914-666-3310
Practice Address - Fax:914-666-7924
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0365791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice