Provider Demographics
NPI:1144409921
Name:IRELAND, CHARLES S III (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:IRELAND
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19001-1619
Mailing Address - Country:US
Mailing Address - Phone:215-706-0607
Mailing Address - Fax:215-706-0260
Practice Address - Street 1:2400 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:PA
Practice Address - Zip Code:19001-1619
Practice Address - Country:US
Practice Address - Phone:215-706-0607
Practice Address - Fax:215-706-0260
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025522-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice