Provider Demographics
NPI:1740273820
Name:UDOLPH, CHARLES H (DDS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:UDOLPH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7345 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1910
Mailing Address - Country:US
Mailing Address - Phone:818-346-6282
Mailing Address - Fax:818-346-5174
Practice Address - Street 1:7345 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 330
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1910
Practice Address - Country:US
Practice Address - Phone:818-346-6282
Practice Address - Fax:818-346-5174
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA216591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB21659OtherDENTI-CAL