Provider Demographics
NPI:1518020627
Name:DEROO, CHARLES C (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:DEROO
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:200 FORBES ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1538
Mailing Address - Country:US
Mailing Address - Phone:443-603-9000
Mailing Address - Fax:443-603-9010
Practice Address - Street 1:405 FREDERICK RD
Practice Address - Street 2:SUITE 150
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4645
Practice Address - Country:US
Practice Address - Phone:410-747-0077
Practice Address - Fax:410-744-3135
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD84551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics