Provider Demographics
NPI:1790389922
Name:NARITA, CHARLENE (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:NARITA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11585 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3540
Mailing Address - Country:US
Mailing Address - Phone:209-355-4577
Mailing Address - Fax:
Practice Address - Street 1:490 S FARRELL DR STE C101
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7962
Practice Address - Country:US
Practice Address - Phone:760-320-7621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105578122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist