Provider Demographics
NPI:1164414835
Name:CHARLTON, DENNIS J (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:CHARLTON
Suffix:
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 1:2630 SANDY LAKE GROVE CITY RD
Mailing Address - Street 2:
Mailing Address - City:STONEBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16153-2830
Mailing Address - Country:US
Mailing Address - Phone:724-376-3361
Mailing Address - Fax:724-376-3754
Practice Address - Street 1:3242 SOUTH MAIN STREET
Practice Address - Street 2:BOX 487
Practice Address - City:SANDY LAKE
Practice Address - State:PA
Practice Address - Zip Code:16145
Practice Address - Country:US
Practice Address - Phone:724-376-7161
Practice Address - Fax:724-376-3754
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022280L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice