Provider Demographics
NPI:1740334655
Name:SCHILDROTH, CHARLES JOSEPH JR (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:SCHILDROTH
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 BAYOU BLVD
Mailing Address - Street 2:STE.4
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2193
Mailing Address - Country:US
Mailing Address - Phone:850-477-3188
Mailing Address - Fax:850-477-6776
Practice Address - Street 1:5120 BAYOU BLVD
Practice Address - Street 2:STE.4
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2193
Practice Address - Country:US
Practice Address - Phone:850-477-3188
Practice Address - Fax:850-477-6776
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0119101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSAFEGUARDOther9830
FL25852OtherUNITED HEALTHCARE
FLAETNAOther109808
FLCOMPBENEFITSOther995573
FL724127OtherUNITED CONCORDIA