Provider Demographics
NPI:1659483212
Name:DEUTSCH, CHARLES MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MARTIN
Last Name:DEUTSCH
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 1:313 PARK AVENUE
Mailing Address - Street 2:204
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046
Mailing Address - Country:US
Mailing Address - Phone:703-534-7171
Mailing Address - Fax:703-534-7174
Practice Address - Street 1:313 PARK AVENUE
Practice Address - Street 2:204
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046
Practice Address - Country:US
Practice Address - Phone:703-534-7171
Practice Address - Fax:703-534-7174
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVIRGINIA03830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist