Provider Demographics
NPI:1083817142
Name:CHARLES, MAKEPEACE B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAKEPEACE
Middle Name:B
Last Name:CHARLES
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 1:2560 RCA BLVD.
Mailing Address - Street 2:SUITE #102
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3335
Mailing Address - Country:US
Mailing Address - Phone:561-622-9065
Mailing Address - Fax:
Practice Address - Street 1:2560 RCA BLVD.
Practice Address - Street 2:SUITE #102
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3335
Practice Address - Country:US
Practice Address - Phone:561-622-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070119401223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery