Provider Demographics
NPI:1891195541
Name:WALOWITZ, CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:WALOWITZ
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 1:1 GRAND ARMY PLZ
Mailing Address - Street 2:APT 5-C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-5611
Mailing Address - Country:US
Mailing Address - Phone:410-336-1419
Mailing Address - Fax:
Practice Address - Street 1:1 GRAND ARMY PLZ
Practice Address - Street 2:APT 5-C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5611
Practice Address - Country:US
Practice Address - Phone:410-336-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-31
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY82119801223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics