Provider Demographics
NPI:1235249061
Name:CHARLETTA, JOHN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:CHARLETTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:228 MCKEAN AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022
Mailing Address - Country:US
Mailing Address - Phone:724-483-8079
Mailing Address - Fax:724-483-9466
Practice Address - Street 1:228 MCKEAN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022
Practice Address - Country:US
Practice Address - Phone:724-483-8079
Practice Address - Fax:724-483-9466
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020780L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist