Provider Demographics
NPI:1568508349
Name:RUEFENACHT, CHARLES WALTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WALTER
Last Name:RUEFENACHT
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 1:3509 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4505
Mailing Address - Country:US
Mailing Address - Phone:925-284-2203
Mailing Address - Fax:925-283-9436
Practice Address - Street 1:3509 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4505
Practice Address - Country:US
Practice Address - Phone:925-284-2203
Practice Address - Fax:925-283-9436
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0318541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice