Provider Demographics
NPI:1467910786
Name:PASCAL, CHARLOTTE (CERTIFICATE)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:PASCAL
Suffix:
Gender:F
Credentials:CERTIFICATE
Other - Prefix:MISS
Other - First Name:CHARLOTTE
Other - Middle Name:EMMANUELA
Other - Last Name:PASCAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14 VFW PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-7723
Mailing Address - Country:US
Mailing Address - Phone:774-826-1205
Mailing Address - Fax:
Practice Address - Street 1:14 VFW PKWY
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-7723
Practice Address - Country:US
Practice Address - Phone:774-826-1205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1993OtherSELF