Provider Demographics
NPI:1104792217
Name:CALE, CHARLES DUSTIN
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DUSTIN
Last Name:CALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8774 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-2162
Mailing Address - Country:US
Mailing Address - Phone:918-568-7106
Mailing Address - Fax:
Practice Address - Street 1:8774 E 3RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-2162
Practice Address - Country:US
Practice Address - Phone:918-568-7106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator