Provider Demographics
NPI:1629159769
Name:STRAUSS, CHARLES WERNER (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WERNER
Last Name:STRAUSS
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 1:19 BRADDOCK PT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-0809
Mailing Address - Country:US
Mailing Address - Phone:803-738-9988
Mailing Address - Fax:
Practice Address - Street 1:200 GILLS CREEK PARKWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1224
Practice Address - Country:US
Practice Address - Phone:803-695-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice