Provider Demographics
NPI:1790743730
Name:LAUN, CHUCK J (DDS)
Entity Type:Individual
Prefix:
First Name:CHUCK
Middle Name:J
Last Name:LAUN
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 1:23036 STATE ROAD 54
Mailing Address - Street 2:SUITE 403
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-6968
Mailing Address - Country:US
Mailing Address - Phone:813-909-1317
Mailing Address - Fax:813-949-1630
Practice Address - Street 1:23036 STATE ROAD 54
Practice Address - Street 2:SUITE 403
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-6968
Practice Address - Country:US
Practice Address - Phone:813-909-1317
Practice Address - Fax:813-949-1630
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 17689122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist