Provider Demographics
NPI:1558140657
Name:CHARLES ELWELL III, D.M.D., P.A.
Entity Type:Organization
Organization Name:CHARLES ELWELL III, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:ELWELL
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-366-8882
Mailing Address - Street 1:3307 CLARK RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8419
Mailing Address - Country:US
Mailing Address - Phone:941-366-8882
Mailing Address - Fax:
Practice Address - Street 1:3307 CLARK RD STE 104
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-8419
Practice Address - Country:US
Practice Address - Phone:941-366-8882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental