Provider Demographics
NPI:1881848984
Name:AGRIESTI, CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:AGRIESTI
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 1:2838 HICKORY HILL RD
Mailing Address - Street 2:#34
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-2178
Mailing Address - Country:US
Mailing Address - Phone:901-794-8334
Mailing Address - Fax:901-362-8848
Practice Address - Street 1:2838 HICKORY HILL RD
Practice Address - Street 2:#34
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2178
Practice Address - Country:US
Practice Address - Phone:901-794-8334
Practice Address - Fax:901-362-8848
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist