Provider Demographics
NPI:1598930703
Name:CHARLES G NEW DDS MS PA
Entity Type:Organization
Organization Name:CHARLES G NEW DDS MS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:NEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-659-6640
Mailing Address - Street 1:1900 S HAWTHORNE RD
Mailing Address - Street 2:SUITE 254
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3913
Mailing Address - Country:US
Mailing Address - Phone:336-659-6640
Mailing Address - Fax:336-659-3890
Practice Address - Street 1:1900 S HAWTHORNE RD
Practice Address - Street 2:SUITE 254
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3913
Practice Address - Country:US
Practice Address - Phone:336-659-6640
Practice Address - Fax:336-659-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5762261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental