Provider Demographics
NPI:1902010713
Name:STAMITOLES, CHARLES E (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:STAMITOLES
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 1:1025 CREIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7031
Mailing Address - Country:US
Mailing Address - Phone:850-478-3330
Mailing Address - Fax:
Practice Address - Street 1:1025 CREIGHTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7031
Practice Address - Country:US
Practice Address - Phone:850-478-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice