Provider Demographics
NPI:1508823139
Name:PUFFER, CHARLES WALTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WALTER
Last Name:PUFFER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14120 COMMERCE AVE NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-1500
Mailing Address - Country:US
Mailing Address - Phone:952-447-1080
Mailing Address - Fax:952-447-0376
Practice Address - Street 1:14120 COMMERCE AVE NE
Practice Address - Street 2:SUITE 300
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1500
Practice Address - Country:US
Practice Address - Phone:952-447-1080
Practice Address - Fax:952-447-0376
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND83031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice