Provider Demographics
NPI:1184978835
Name:JOE, CHARLENE TL (PRIMARY DENTAL HEALT)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:TL
Last Name:JOE
Suffix:
Gender:F
Credentials:PRIMARY DENTAL HEALT
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 528
Mailing Address - Street 2:YKHC
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0528
Mailing Address - Country:US
Mailing Address - Phone:907-543-6229
Mailing Address - Fax:907-543-6393
Practice Address - Street 1:212 WILLIOW STREET
Practice Address - Street 2:CHEVAK CLINIC
Practice Address - City:CHEVAK
Practice Address - State:AK
Practice Address - Zip Code:99563
Practice Address - Country:US
Practice Address - Phone:907-858-7029
Practice Address - Fax:907-858-7456
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other