Provider Demographics
NPI:1649375106
Name:BODE, CHARLES G (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:G
Last Name:BODE
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:5750 W THUNDERBIRD RD
Mailing Address - Street 2:H-850
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4660
Mailing Address - Country:US
Mailing Address - Phone:602-938-0880
Mailing Address - Fax:602-547-0528
Practice Address - Street 1:5750 W THUNDERBIRD RD
Practice Address - Street 2:H-850
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4660
Practice Address - Country:US
Practice Address - Phone:602-938-0880
Practice Address - Fax:602-547-0528
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ25791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0116750OtherBCBS
AZ823999OtherUNITED CONCORDIA
AZ082115OtherCMDP