Provider Demographics
NPI:1205591385
Name:CHARLES H SURLES DDS PA
Entity type:Organization
Organization Name:CHARLES H SURLES DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HERMAN
Authorized Official - Last Name:SURLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-870-1868
Mailing Address - Street 1:404 LINDSAY ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4879
Mailing Address - Country:US
Mailing Address - Phone:336-882-9820
Mailing Address - Fax:
Practice Address - Street 1:404 LINDSAY ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4879
Practice Address - Country:US
Practice Address - Phone:336-882-9820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295850352OtherDENTIST