Provider Demographics
NPI:1346336294
Name:CHARMOLI, SCOTT W (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
Last Name:CHARMOLI
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 1:73 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-8739
Mailing Address - Country:US
Mailing Address - Phone:262-673-2960
Mailing Address - Fax:
Practice Address - Street 1:73 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-8739
Practice Address - Country:US
Practice Address - Phone:262-673-2960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice