Provider Demographics
NPI:1245410232
Name:CHARLES CLAUSEN DDS PC
Entity type:Organization
Organization Name:CHARLES CLAUSEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-848-0100
Mailing Address - Street 1:13055 W MCDOWELL
Mailing Address - Street 2:#G103
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392
Mailing Address - Country:US
Mailing Address - Phone:623-848-0100
Mailing Address - Fax:623-848-3516
Practice Address - Street 1:13055 W MCDOWELL
Practice Address - Street 2:#G103
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392
Practice Address - Country:US
Practice Address - Phone:623-848-0100
Practice Address - Fax:623-848-3516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty