Provider Demographics
NPI:1417949660
Name:CRISLER, CHARLES E (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:CRISLER
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 1:1507 W KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1383
Mailing Address - Country:US
Mailing Address - Phone:715-234-6846
Mailing Address - Fax:715-234-0014
Practice Address - Street 1:1507 W KNAPP ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1383
Practice Address - Country:US
Practice Address - Phone:715-234-6846
Practice Address - Fax:715-234-0014
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4527-WI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice