Provider Demographics
NPI:1902818982
Name:STOUP, CHARLES L JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:STOUP
Suffix:JR
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 1:820 BELVEDERE STREET
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013
Mailing Address - Country:US
Mailing Address - Phone:717-243-0300
Mailing Address - Fax:717-243-2268
Practice Address - Street 1:820 BELVEDERE ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-4018
Practice Address - Country:US
Practice Address - Phone:717-243-0300
Practice Address - Fax:717-243-2268
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017332L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice