Provider Demographics
NPI:1669477758
Name:MASSLER, CHARLES FRANK JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FRANK
Last Name:MASSLER
Suffix:JR
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:DEPARTMENT OF DENTISTRY, WFUSM
Mailing Address - Street 2:MEDICAL CENTER BOULEVARD
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-1093
Mailing Address - Country:US
Mailing Address - Phone:336-716-2164
Mailing Address - Fax:336-716-9045
Practice Address - Street 1:DEPARTMENT OF DENTISTRY, WFUSM
Practice Address - Street 2:MEDICAL CENTER BOULEVARD
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1093
Practice Address - Country:US
Practice Address - Phone:336-716-2164
Practice Address - Fax:336-716-9045
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69411223G0001X
VA04010082301223G0001X
MO0129501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9004EOtherBLUE CROSS / BLUE SHIELD
NC799004EMedicaid
NC799004EMedicaid