Provider Demographics
NPI:1396819587
Name:ROBERSON-INOUYE, CHARLOTTE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:ELIZABETH
Last Name:ROBERSON-INOUYE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHARLOTTE
Other - Middle Name:ELIZABETH
Other - Last Name:ROBERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:11239 TAMPA AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1615
Mailing Address - Country:US
Mailing Address - Phone:818-368-6266
Mailing Address - Fax:818-366-2491
Practice Address - Street 1:11239 TAMPA AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-1615
Practice Address - Country:US
Practice Address - Phone:818-368-6266
Practice Address - Fax:818-366-2491
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29997OtherCALIFORNIA DENTAL LICENSE