Provider Demographics
NPI:1598961401
Name:CHARNECO, ANTONIO RAFAEL JR (DMD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:RAFAEL
Last Name:CHARNECO
Suffix:JR
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 1:380 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:WARRENDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15086-7563
Mailing Address - Country:US
Mailing Address - Phone:724-935-9966
Mailing Address - Fax:
Practice Address - Street 1:380 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:WARRENDALE
Practice Address - State:PA
Practice Address - Zip Code:15086-7563
Practice Address - Country:US
Practice Address - Phone:724-935-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028405L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics