Provider Demographics
NPI:1578764791
Name:CHARNAS, MITCHEL A (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITCHEL
Middle Name:A
Last Name:CHARNAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MADISON AVE
Mailing Address - Street 2:2201
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3903
Mailing Address - Country:US
Mailing Address - Phone:212-683-2530
Mailing Address - Fax:
Practice Address - Street 1:200 MADISON AVE
Practice Address - Street 2:SUITE 2201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3903
Practice Address - Country:US
Practice Address - Phone:212-683-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0361001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice