Provider Demographics
NPI:1467479188
Name:WYGODSKI, CHARLENE O (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:O
Last Name:WYGODSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5762 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7914
Mailing Address - Country:US
Mailing Address - Phone:727-384-4151
Mailing Address - Fax:727-381-2240
Practice Address - Street 1:5762 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7914
Practice Address - Country:US
Practice Address - Phone:727-384-4151
Practice Address - Fax:727-381-2240
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 106761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice