Provider Demographics
NPI:1942397435
Name:ANDEREGG, CHARLES R JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:ANDEREGG
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14655 BEL RED RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3900
Mailing Address - Country:US
Mailing Address - Phone:425-747-7007
Mailing Address - Fax:425-747-7342
Practice Address - Street 1:14655 BEL RED RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3900
Practice Address - Country:US
Practice Address - Phone:425-747-7007
Practice Address - Fax:425-747-7342
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000068331223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics