Provider Demographics
NPI:1164488235
Name:FERZLI, CHARLES (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:FERZLI
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 1:2504 BROOK CROSSING CIR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3169
Mailing Address - Country:US
Mailing Address - Phone:919-462-3350
Mailing Address - Fax:
Practice Address - Street 1:915 KILDAIRE FARM RD
Practice Address - Street 2:SUITE 7
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3936
Practice Address - Country:US
Practice Address - Phone:919-462-3350
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902F4Medicaid
NC50844-1OtherUHC PROVIDER NO.
NC902F4OtherBCBS OF NC