Provider Demographics
NPI:1972853661
Name:CAGE, CHARLIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLIE
Middle Name:
Last Name:CAGE
Suffix:
Gender:F
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:DENTAL CORPS PROGRAMS CODE 1WPGDC
Mailing Address - Street 2:8955 WOOD ROAD
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5628
Mailing Address - Country:US
Mailing Address - Phone:301-295-0650
Mailing Address - Fax:
Practice Address - Street 1:DENTAL CORPS PROGRAMS CODE 1WPGDC
Practice Address - Street 2:8955 WOOD RD
Practice Address - City:BESTHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5628
Practice Address - Country:US
Practice Address - Phone:301-295-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist