Provider Demographics
NPI:1497085369
Name:RO, CHARLES J (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:RO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 BERGENLINE AVE. 2ND FL
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087
Mailing Address - Country:US
Mailing Address - Phone:201-724-9743
Mailing Address - Fax:
Practice Address - Street 1:765 QUEEN ANNE RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3331
Practice Address - Country:US
Practice Address - Phone:201-836-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024288001223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty