Provider Demographics
NPI:1598986820
Name:AXELRAD, CHARLES STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:STEVEN
Last Name:AXELRAD
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 1:260 MERRITTS RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3200
Mailing Address - Country:US
Mailing Address - Phone:561-249-4206
Mailing Address - Fax:516-249-8141
Practice Address - Street 1:260 MERRITTS RD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3200
Practice Address - Country:US
Practice Address - Phone:561-249-4206
Practice Address - Fax:516-249-8141
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty