Provider Demographics
NPI:1780684134
Name:CARLILE, CHARLES DAREN (DMD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAREN
Last Name:CARLILE
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 1:12157 W COOPER DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4861
Mailing Address - Country:US
Mailing Address - Phone:303-973-6797
Mailing Address - Fax:303-933-5897
Practice Address - Street 1:6901 S PIERCE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-7202
Practice Address - Country:US
Practice Address - Phone:303-973-1900
Practice Address - Fax:303-933-5897
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO70081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice