Provider Demographics
NPI:1558447110
Name:FELDMAN, CHARLES LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LEE
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 SAINT MARKS PLZ
Mailing Address - Street 2:SUITE 7
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6409
Mailing Address - Country:US
Mailing Address - Phone:209-957-8776
Mailing Address - Fax:209-957-0965
Practice Address - Street 1:1502 SAINT MARKS PLZ
Practice Address - Street 2:SUITE 7
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6409
Practice Address - Country:US
Practice Address - Phone:209-957-8776
Practice Address - Fax:209-957-0965
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA032547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist