Provider Demographics
NPI:1558379347
Name:ANONUEVO, CHARLESPAUL T (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLESPAUL
Middle Name:T
Last Name:ANONUEVO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:T
Other - Last Name:ANONUEVO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:8810 BLAKENEY PROFESSIONAL DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6654
Mailing Address - Country:US
Mailing Address - Phone:704-540-1900
Mailing Address - Fax:844-891-7162
Practice Address - Street 1:8810 BLAKENEY PROFESSIONAL DR STE 120
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6654
Practice Address - Country:US
Practice Address - Phone:704-540-1900
Practice Address - Fax:844-891-7162
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190271101223G0001X
NC8858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice