Provider Demographics
NPI:1558791566
Name:CHARLES R PAYERLE DDS, MD PLLC
Entity Type:Organization
Organization Name:CHARLES R PAYERLE DDS, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PAYERLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-568-6811
Mailing Address - Street 1:12001 SOUTH FWY STE 207
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7214
Mailing Address - Country:US
Mailing Address - Phone:817-568-6811
Mailing Address - Fax:817-568-6813
Practice Address - Street 1:12001 SOUTH FWY STE 207
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7214
Practice Address - Country:US
Practice Address - Phone:817-568-6811
Practice Address - Fax:817-568-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23735261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery