Provider Demographics
NPI:1972716397
Name:PULEO, CHARLES ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROBERT
Last Name:PULEO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BLEVENS DR
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-5203
Mailing Address - Country:US
Mailing Address - Phone:603-774-3524
Mailing Address - Fax:
Practice Address - Street 1:64 MYRTLE ST EXT
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:NH
Practice Address - Zip Code:03244-2158
Practice Address - Country:US
Practice Address - Phone:603-464-5580
Practice Address - Fax:603-464-4317
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH22021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice