Provider Demographics
NPI:1588861009
Name:MEINERSHAGEN, CHARLES I (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:I
Last Name:MEINERSHAGEN
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 1:980 LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-1724
Mailing Address - Country:US
Mailing Address - Phone:530-246-7237
Mailing Address - Fax:530-246-0875
Practice Address - Street 1:980 LAKE BLVD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-1724
Practice Address - Country:US
Practice Address - Phone:530-246-7237
Practice Address - Fax:530-246-0875
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice