Provider Demographics
NPI:1508958190
Name:MILLSTEIN, CHARLES B (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:B
Last Name:MILLSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1648 MASSACHUSETTS AVE
Mailing Address - Street 2:# 1
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2718
Mailing Address - Country:US
Mailing Address - Phone:617-876-4004
Mailing Address - Fax:617-984-2674
Practice Address - Street 1:1648 MASSACHUSETTS AVE
Practice Address - Street 2:# 1
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-2718
Practice Address - Country:US
Practice Address - Phone:617-876-4004
Practice Address - Fax:617-984-2674
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA97191223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics