Provider Demographics
NPI:1952671539
Name:CHARLES, BERNADETTE ANN (DHAT)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:ANN
Last Name:CHARLES
Suffix:
Gender:F
Credentials:DHAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 310
Mailing Address - Street 2:
Mailing Address - City:ST. MARY'S
Mailing Address - State:AK
Mailing Address - Zip Code:99658
Mailing Address - Country:US
Mailing Address - Phone:907-438-3500
Mailing Address - Fax:907-438-3540
Practice Address - Street 1:310 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:ST. MARY'S
Practice Address - State:AK
Practice Address - Zip Code:99658
Practice Address - Country:US
Practice Address - Phone:907-438-3500
Practice Address - Fax:907-438-3540
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant