Provider Demographics
NPI:1871819292
Name:CHARLES R PAYERLE, DDS, MD, PLLC
Entity Type:Organization
Organization Name:CHARLES R PAYERLE, DDS, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAYERLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD, LLC
Authorized Official - Phone:817-568-6811
Mailing Address - Street 1:12001 SOUTH FWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7208
Mailing Address - Country:US
Mailing Address - Phone:817-568-6811
Mailing Address - Fax:817-568-6813
Practice Address - Street 1:12001 SOUTH FWY
Practice Address - Street 2:SUITE 207
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7208
Practice Address - Country:US
Practice Address - Phone:817-568-6811
Practice Address - Fax:817-568-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00237351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1780894170OtherNPI