Provider Demographics
NPI:1265677116
Name:DI BARI, CHARLES SALVATORE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SALVATORE
Last Name:DI BARI
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 1:2503 E HATCH RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-4817
Mailing Address - Country:US
Mailing Address - Phone:209-537-5783
Mailing Address - Fax:209-537-0443
Practice Address - Street 1:2503 E HATCH RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-4817
Practice Address - Country:US
Practice Address - Phone:209-537-5783
Practice Address - Fax:209-537-0443
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice