Provider Demographics
NPI:1831113794
Name:SANDILOS, CHARLES G (DMD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:G
Last Name:SANDILOS
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 1:150 E BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-4427
Mailing Address - Country:US
Mailing Address - Phone:215-628-3955
Mailing Address - Fax:215-628-3511
Practice Address - Street 1:150 E BUTLER AVE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-4427
Practice Address - Country:US
Practice Address - Phone:215-628-3955
Practice Address - Fax:215-628-3511
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019821L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice